Provider Demographics
NPI:1902790892
Name:DAVIS HALL, AFFTIN L
Entity type:Individual
Prefix:MRS
First Name:AFFTIN
Middle Name:L
Last Name:DAVIS HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AFFTIN
Other - Middle Name:L
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 BRYANT AVE
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-2118
Mailing Address - Country:US
Mailing Address - Phone:914-882-4141
Mailing Address - Fax:
Practice Address - Street 1:16 KNIGHT ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-4725
Practice Address - Country:US
Practice Address - Phone:914-882-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374700000X
CT001179247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No374700000XNursing Service Related ProvidersTechnician