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NPI Code Detail

MEDICARE: NEDRA SHIELDS

MEDICARE: NEDRA SHIELDS
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1225388010
Entity Type Code : Individual
Provider Name (Legal Business Name) : NEDRA SHIELDS
Provider Business Mailing Address
First Line : 7212 ELITE CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-5988
Country : US
Telephone Number : 702-372-7964
Fax Number :
Provider Business Practice Location Address
First Line : 7212 ELITE CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-5988
Country : US
Telephone Number : 702-372-7964
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2012
Last Update Date : 09/19/2012

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Directions to “ NEDRA SHIELDS ” Practice Location

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