MEDICARE: NIANI JEWEL 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1629534789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIANI JEWEL TAYLOR

Provider Business Mailing Address
First Line	:	6521 ANGEL MOUNTAIN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-1844
Country	:	US
Telephone Number	:	702-882-9552
Fax Number	:	702-455-7180

Provider Business Practice Location Address
First Line	:	6521 ANGEL MOUNTAIN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-1844
Country	:	US
Telephone Number	:	702-882-9552
Fax Number	:

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

Provider Enumeration Date	:	02/13/2019
Last Update Date	:	02/13/2019

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Directions to “ NIANI JEWEL TAYLOR ” Practice Location

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