MEDICARE: ZIVON SEWELL

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

General Provider Information

NPI Number	:	1336568112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZIVON SEWELL

Provider Business Mailing Address
First Line	:	2242 ENGLESTAD ST
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030-4031
Country	:	US
Telephone Number	:	702-813-7432
Fax Number	:	702-586-6645

Provider Business Practice Location Address
First Line	:	2242 ENGLESTAD ST
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89030-4031
Country	:	US
Telephone Number	:	702-813-7432
Fax Number	:	702-586-6645

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

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	04/09/2014

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Directions to “ ZIVON SEWELL ” Practice Location

Language	Start Address	Practice Location

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