Provider Demographics
NPI:1790523397
Name:DAVIS-PICKETT, SHAVONE (CNA/PCT)
Entity type:Individual
Prefix:
First Name:SHAVONE
Middle Name:
Last Name:DAVIS-PICKETT
Suffix:
Gender:F
Credentials:CNA/PCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SANTA MARGARITA
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-1927
Mailing Address - Country:US
Mailing Address - Phone:510-827-8469
Mailing Address - Fax:
Practice Address - Street 1:699 LEWELLING BLVD STE 146357
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94579-1870
Practice Address - Country:US
Practice Address - Phone:510-827-8469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01103966376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide