Provider Demographics
NPI:1801114541
Name:DAVIS, ADEYLAH Z (LPN)
Entity type:Individual
Prefix:
First Name:ADEYLAH
Middle Name:Z
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 PORTLAND CT
Mailing Address - Street 2:APT. 4
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-2805
Mailing Address - Country:US
Mailing Address - Phone:585-323-9179
Mailing Address - Fax:
Practice Address - Street 1:73 PORTLAND CT
Practice Address - Street 2:APT. 4
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2805
Practice Address - Country:US
Practice Address - Phone:585-323-9179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269055164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse