MEDICARE: SHERILL BANKS-MADDOX

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
2	172V00000X	Community Health Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720477755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERILL BANKS-MADDOX

Provider Business Mailing Address
First Line	:	1058 W. OWENS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106
Country	:	US
Telephone Number	:	702-749-7444
Fax Number	:	702-749-7844

Provider Business Practice Location Address
First Line	:	431 S 6TH ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6915
Country	:	US
Telephone Number	:	702-762-5633
Fax Number	:	702-749-7844

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

Provider Enumeration Date	:	01/14/2015
Last Update Date	:	04/24/2020

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Directions to “ SHERILL BANKS-MADDOX ” Practice Location

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