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General NPI Number Information
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NPI Number | 1215576749
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Entity Type | Individual
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Provider Name | SARAIDA SAMONE TISDALE
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Gender | Female
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Dates
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Enumeration Date | 01/01/2020
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 5940 S RAINBOW BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89118
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Country | US
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Telephone | 888-531-8385
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Fax |
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Provider Business Mailing Address
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Address Line | 9001 WINCHESTER RIDGE ST
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City | LAS VEGAS
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State | NV
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Zip | 89139-7473
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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