Provider Demographics
NPI:1235937624
Name:DAVIS, AMANDIA BEATRICE
Entity type:Individual
Prefix:
First Name:AMANDIA
Middle Name:BEATRICE
Last Name:DAVIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 NEWTON DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-7025
Mailing Address - Country:US
Mailing Address - Phone:702-366-5083
Mailing Address - Fax:
Practice Address - Street 1:2300 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4352
Practice Address - Country:US
Practice Address - Phone:702-815-9012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-03
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health