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General NPI Number Information
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NPI Number | 1720477755
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Entity Type | Individual
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Provider Name | SHERILL BANKS-MADDOX
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Gender | Female
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 04/24/2020
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Provider Practice Location Address
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Address Line | 431 S 6TH ST
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City | LAS VEGAS
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State | NV
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Zip | 89101-6915
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Country | US
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Telephone | 702-762-5633
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Fax | 702-749-7844
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Provider Business Mailing Address
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Address Line | 1058 W. OWENS AVE
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City | LAS VEGAS
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State | NV
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Zip | 89106
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Country | US
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Telephone | 702-749-7444
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Fax | 702-749-7844
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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