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NPI Code Detail

MEDICARE: SHAKENDRA LEE RN

MEDICARE: SHAKENDRA LEE RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse846512NV
2163WP0808XPsychiatric/Mental Health Registered Nurse846512NV
3167G00000XLicensed Psychiatric Technician

General Provider Information

NPI Number : 1063976462
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAKENDRA LEE RN
Provider Business Mailing Address
First Line : 3035 S MARYLAND PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2200
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3035 S MARYLAND PKWY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89109-2200
Country : US
Telephone Number : 702-376-4557
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2019
Last Update Date : 08/20/2025

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