Healthcare Provider Details

I. General information

NPI: 1508158635
Provider Name (Legal Business Name): NYETTA SHANEE ABERNATHY M.ED, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2011
Last Update Date: 02/03/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S RANCHO DR STE A
LAS VEGAS NV
89106-4849
US

IV. Provider business mailing address

3320 SALMON CREEK DR
LAS VEGAS NV
89129-6186
US

V. Phone/Fax

Practice location:
  • Phone: 702-998-9505
  • Fax: 702-527-7939
Mailing address:
  • Phone: 702-526-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-110527
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-56396
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: