Healthcare Provider Details

I. General information

NPI: 1578071007
Provider Name (Legal Business Name): SHYNDONA LYNETTE DICKERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHYNDONA YOUNG

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W SAHARA AVE STE 800
LAS VEGAS NV
89102-4397
US

IV. Provider business mailing address

2300 W SAHARA AVE STE 800
LAS VEGAS NV
89102-4397
US

V. Phone/Fax

Practice location:
  • Phone: 702-604-2448
  • Fax: 725-605-5874
Mailing address:
  • Phone: 702-604-2448
  • Fax: 725-605-5874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberCNA023075
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number10472-PCS-0
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: