MEDICARE: SHAUNTA MARIE GRAYSON

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	251S00000X	Community/Behavioral Health Agency		NV

General Provider Information

NPI Number	:	1750792750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUNTA MARIE GRAYSON

Provider Business Mailing Address
First Line	:	2961 SAVERS CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-7444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2961 SAVERS CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-7444
Country	:	US
Telephone Number	:	702-588-3742
Fax Number	:

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

Provider Enumeration Date	:	05/13/2014
Last Update Date	:	05/13/2014

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