Provider Demographics
NPI:1932954088
Name:DAVIS, DAYO SUDIYAH
Entity Type:Individual
Prefix:
First Name:DAYO
Middle Name:SUDIYAH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ALEXANDRIA CT
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-4726
Mailing Address - Country:US
Mailing Address - Phone:248-756-4647
Mailing Address - Fax:
Practice Address - Street 1:25448 E RIVER RD
Practice Address - Street 2:
Practice Address - City:GROSSE ILE
Practice Address - State:MI
Practice Address - Zip Code:48138-1857
Practice Address - Country:US
Practice Address - Phone:248-453-7247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704376329163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse