Healthcare Provider Details

I. General information

NPI: 1114268398
Provider Name (Legal Business Name): SHEYANE FAGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 S 3RD ST
LAS VEGAS NV
89101-5914
US

IV. Provider business mailing address

PO BOX 700
INDIAN SPRINGS NV
89018-0700
US

V. Phone/Fax

Practice location:
  • Phone: 702-751-2535
  • Fax:
Mailing address:
  • Phone: 702-379-7298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number103K000000X
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: