Individual
SHAWNA CHARNISSA DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3817 28TH ST, LONG ISLAND CITY, NY 11101-2727
(646) 522-2528
Mailing address
3817 28TH ST, LONG ISLAND CITY, NY 11101-2727
(646) 522-2529
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
338905
NY
208D00000X
General Practice Physician
338905
NY
363L00000X
Nurse Practitioner
Primary
338905
NY
Other
Enumeration date
10/16/2014
Last updated
02/21/2022
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