Provider Demographics
NPI:1881123008
Name:DAVIES, SAMANTHA MCCAULEY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MCCAULEY
Last Name:DAVIES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1116
Mailing Address - Country:US
Mailing Address - Phone:845-514-3840
Mailing Address - Fax:
Practice Address - Street 1:512 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-1702
Practice Address - Country:US
Practice Address - Phone:315-435-4625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist