Individual
DIANE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC SLP
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
SA2350
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10620901
CITURS INDIVIDUAL NUM NPR
FL
01
—
10620902
CITRUS INDIVIDUAL NUM SH
FL
01
—
215753
AMERIGROUP NUMBER
FL
01
—
282700
AVMED
FL
05
—
880842200
—
FL
01
—
S1760
BLUE CROSS BLUE SHIELD
FL
Enumeration date
02/07/2007
Last updated
04/29/2009
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