MEDICARE: BRIONSHEA LASHAY MOORE

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	106E00000X	Assistant Behavior Analyst		NV

General Provider Information

NPI Number	:	1992220818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIONSHEA LASHAY MOORE

Provider Business Mailing Address
First Line	:	3749 WEBFOOT RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-1575
Country	:	US
Telephone Number	:	702-377-9880
Fax Number	:

Provider Business Practice Location Address
First Line	:	3440 E RUSSELL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-2201
Country	:	US
Telephone Number	:	702-214-4398
Fax Number	:	702-214-4254

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

Provider Enumeration Date	:	08/11/2017
Last Update Date	:	08/11/2017

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