Provider Demographics
NPI:1548154131
Name:DAVIS, IEASHA EBONEY
Entity type:Individual
Prefix:
First Name:IEASHA
Middle Name:EBONEY
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N PARKWAY DR APT 1171101N
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728-2742
Mailing Address - Country:US
Mailing Address - Phone:510-712-5277
Mailing Address - Fax:
Practice Address - Street 1:1101 N PARKWAY DR APT 1171101N
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-2742
Practice Address - Country:US
Practice Address - Phone:510-712-5277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician