MEDICARE: RASHIRA SHAWAN TAYLOR

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	3747P1801X	Personal Care Attendant
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1205481744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RASHIRA SHAWAN TAYLOR

Provider Business Mailing Address
First Line	:	2110 E FLAMINGO RD STE 110
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5191
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2112 PINK CORAL DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-0985
Country	:	US
Telephone Number	:	504-292-9536
Fax Number	:

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

Provider Enumeration Date	:	08/01/2019
Last Update Date	:	10/02/2019

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