Individual
DR. SHANNON MICHELLE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
15303 S 94TH AVE STE 110, ORLAND PARK, IL 60462-3825
(800) 991-6117
(888) 812-8191
Mailing address
3820 NORTHDALE BLVD STE 201, TAMPA, FL 33624-1893
(813) 280-0705
(813) 434-2023
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
036164424
IL
208600000X
Surgery Physician
02003690A
IN
208600000X
Surgery Physician
Primary
036164424
IL
208600000X
Surgery Physician
05142
KY
208600000X
Surgery Physician
34.015496
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0470386
—
OH
05
—
200992420
—
IN
05
—
7100787770
—
KY
Enumeration date
04/06/2007
Last updated
02/15/2025
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