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NPI Code Detail

MEDICARE: SHANTAE GAUFF

MEDICARE: SHANTAE GAUFF
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1760828727
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANTAE GAUFF
Provider Business Mailing Address
First Line : 6360 S PECOS RD STE 4
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-3295
Country : US
Telephone Number : 702-816-3400
Fax Number :
Provider Business Practice Location Address
First Line : 6360 S PECOS RD STE 4
Second Line :
City : LAS VEGAS
State : NV
Zip : 89120-3295
Country : US
Telephone Number : 702-816-3400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2013
Last Update Date : 05/17/2013

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Directions to “ SHANTAE GAUFF ” Practice Location

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