MEDICARE: SHEANTAVIA WALKER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	106S00000X	Behavior Technician
2	171M00000X	Case Manager/Care Coordinator	NV
3	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1144876038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEANTAVIA WALKER

Provider Business Mailing Address
First Line	:	887 LAWRY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2350
Country	:	US
Telephone Number	:	702-824-0004
Fax Number	:

Provider Business Practice Location Address
First Line	:	887 LAWRY AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2350
Country	:	US
Telephone Number	:	702-824-0004
Fax Number	:

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

Provider Enumeration Date	:	08/15/2019
Last Update Date	:	03/18/2026

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Directions to “ SHEANTAVIA WALKER ” Practice Location

Language	Start Address	Practice Location

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