MEDICARE: SHAKEEMIA SHAMEECE ANIFOWOSHE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	174400000X	Specialist
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1255811683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAKEEMIA SHAMEECE ANIFOWOSHE

Provider Business Mailing Address
First Line	:	4832 MAHOGANY DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-4734
Country	:	US
Telephone Number	:	702-945-4366
Fax Number	:

Provider Business Practice Location Address
First Line	:	5552 MESQUITE CREEK ST
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89031-6835
Country	:	US
Telephone Number	:	702-703-9788
Fax Number	:

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

Provider Enumeration Date	:	08/15/2018
Last Update Date	:	05/23/2025

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Directions to “ SHAKEEMIA SHAMEECE ANIFOWOSHE ” Practice Location

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