MEDICARE: SHEMILLIA GREGORY

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
1	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134674492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEMILLIA GREGORY

Provider Business Mailing Address
First Line	:	5803 W CRAIG RD
Second Line	:	STE 105
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2536
Country	:	US
Telephone Number	:	702-901-5000
Fax Number	:	702-901-5201

Provider Business Practice Location Address
First Line	:	5803 W CRAIG RD
Second Line	:	STE 105
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-2536
Country	:	US
Telephone Number	:	702-901-5000
Fax Number	:	702-901-5201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2016
Last Update Date	:	08/16/2016

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Directions to “ SHEMILLIA GREGORY ” Practice Location

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