MEDICARE: TEASHANIQUE SHEIR CALDWELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1403478960	NV

General Provider Information

NPI Number	:	1073943221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEASHANIQUE SHEIR CALDWELL

Provider Business Mailing Address
First Line	:	1572 ORCHARD VALLEY DR
Second Line	:	APT# 2071
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-0704
Country	:	US
Telephone Number	:	702-981-1085
Fax Number	:

Provider Business Practice Location Address
First Line	:	1572 ORCHARD VALLEY DR
Second Line	:	APT# 2071
City	:	LAS VEGAS
State	:	NV
Zip	:	89142-0704
Country	:	US
Telephone Number	:	702-981-1085
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2013
Last Update Date	:	11/24/2013

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Directions to “ TEASHANIQUE SHEIR CALDWELL ” Practice Location

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