Provider Demographics
NPI:1023873437
Name:DAVILA, KRISTEN BRIANA
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:BRIANA
Last Name:DAVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:BRIANA
Other - Last Name:DROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43 STACK DR
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1632
Mailing Address - Country:US
Mailing Address - Phone:347-437-8606
Mailing Address - Fax:
Practice Address - Street 1:255 IONIA AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3546
Practice Address - Country:US
Practice Address - Phone:718-984-1422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1784568241174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist