Healthcare Provider Details

I. General information

NPI: 1811284953
Provider Name (Legal Business Name): CLEAVON STEVE DYSON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 08/15/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8879 W FLAMINGO RD
LAS VEGAS NV
89147-8755
US

IV. Provider business mailing address

6330 CURLEW DR
LAS VEGAS NV
89122-7595
US

V. Phone/Fax

Practice location:
  • Phone: 702-213-0007
  • Fax:
Mailing address:
  • Phone: 702-497-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCHW1-6212
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: