Healthcare Provider Details

I. General information

NPI: 1033036918
Provider Name (Legal Business Name): SHYTAIA CARTER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 W CHARLESTON BLVD
LAS VEGAS NV
89146-1049
US

IV. Provider business mailing address

8945 W RUSSELL RD STE 110
LAS VEGAS NV
89148-1225
US

V. Phone/Fax

Practice location:
  • Phone: 702-476-9294
  • Fax:
Mailing address:
  • Phone: 702-476-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: