Provider Demographics
NPI:1184680282
Name:DAVIS, JENNIFER ANN (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 JENNINGS DR
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-2120
Mailing Address - Country:US
Mailing Address - Phone:954-798-4742
Mailing Address - Fax:
Practice Address - Street 1:2290 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1216
Practice Address - Country:US
Practice Address - Phone:914-337-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME944312080P0203X
NY2209802080P0203X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No171400000XOther Service ProvidersHealth & Wellness Coach