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General NPI Number Information
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NPI Number | 1578071007
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Entity Type | Individual
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Provider Name | SHYNDONA LYNETTE DICKERSON
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Gender | Female
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Dates
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Enumeration Date | 01/18/2018
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 2300 W SAHARA AVE STE 800
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City | LAS VEGAS
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State | NV
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Zip | 89102-4397
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Country | US
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Telephone | 702-604-2448
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Fax | 725-605-5874
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Provider Business Mailing Address
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Address Line | 2300 W SAHARA AVE STE 800
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City | LAS VEGAS
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State | NV
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Zip | 89102-4397
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Country | US
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Telephone | 702-604-2448
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Fax | 725-605-5874
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number | CNA023075
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 10472-PCS-0
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License Number State | NV
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