Healthcare Provider Details

I. General information

NPI: 1891274775
Provider Name (Legal Business Name): MADELYN ROSE SESE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5803 W CRAIG RD STE 105
LAS VEGAS NV
89130-2537
US

IV. Provider business mailing address

5803 W CRAIG RD STE 105
LAS VEGAS NV
89130-2537
US

V. Phone/Fax

Practice location:
  • Phone: 702-901-5200
  • Fax: 702-901-5201
Mailing address:
  • Phone: 702-901-5200
  • Fax: 702-901-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: