Most Relevant Information
Provider Data
| NPI Number: | 1003678806 |
| Provider Name: | SHANIQUA DAVIS CCC-SLP |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: | 5117 |
Most Important Dates
| Enumeration Date: | 01/26/2024 |
| Last Updated: | 01/26/2024 |
Provider Practice Location
7075 GOLDEN OAKS LOOP W
SOUTHAVEN
MS
386719010
Practice Location Phone/Fax
| Phone: | 6622280130 |
| Fax: |
Provider Mailing Location
605 PATTERSON ST APT 3
MEMPHIS
TN
381115854
Provider Mailing Phone/Fax
| Phone: | 6626883156 |
| Fax: |