Individual
SHANNON DAVOULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
55 W AMES CT, PLAINVIEW, NY 11803-2304
(516) 728-4722
Mailing address
55 W AMES CT, PLAINVIEW, NY 11803-2304
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
NY
Other
Enumeration date
08/16/2023
Last updated
08/16/2023
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