Individual
MRS. CONSUELO DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
88 RIDGE ST RM 109, GLENS FALLS, NY 12801-3621
(518) 879-6294
Mailing address
19 TAVERN RD, HADLEY, NY 12835-2100
(518) 879-6294
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0202001
NY
Other
Enumeration date
01/24/2011
Last updated
01/24/2011
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