Provider Demographics
NPI:1477445880
Name:DAVISON, SHAUNESSA
Entity type:Individual
Prefix:
First Name:SHAUNESSA
Middle Name:
Last Name:DAVISON
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 1:3400 N WOODS LN
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72756
Mailing Address - Country:US
Mailing Address - Phone:479-639-3190
Mailing Address - Fax:
Practice Address - Street 1:3400 N WOODS LN
Practice Address - Street 2:3400 N WOODS LN
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-7275
Practice Address - Country:US
Practice Address - Phone:479-251-0028
Practice Address - Fax:224-386-4455
Is Sole Proprietor?:No
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician