Organization
DIANE DAVIS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE DAVIS MS CCC SLP (OWNER)
(727) 375-0600
Entity
Organization
Contact information
Practice address
8050 OLD CR 54, NEW PORT RICHEY, FL 34653-6457
(727) 375-0600
(727) 375-1117
Mailing address
8050 OLD CR 54, NEW PORT RICHEY, FL 34653-6457
(727) 375-0600
(727) 375-1117
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA5926
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10647201
CITRUS NPR GROUP
FL
01
—
10647202
CITRUS SH GROUP
FL
01
—
215753
AMERIGROUP
FL
01
—
282700
AVMED
FL
01
—
704024
ACN GROUP
FL
05
—
885702400
—
FL
01
—
S1760
BCBS
FL
Enumeration date
02/09/2007
Last updated
04/29/2009
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