MEDICARE: ILEANA DEVERAUX

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	390200000X	Student in an Organized Health Care Education/Training Program		TN
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1639933377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILEANA DEVERAUX

Provider Business Mailing Address
First Line	:	461 21ST AVE S
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37240-1104
Country	:	US
Telephone Number	:	702-412-8578
Fax Number	:

Provider Business Practice Location Address
First Line	:	5765 S RAINBOW BLVD STE 101-102
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-2536
Country	:	US
Telephone Number	:	702-412-8578
Fax Number	:

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

Provider Enumeration Date	:	02/13/2024
Last Update Date	:	03/07/2026

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Directions to “ ILEANA DEVERAUX ” Practice Location

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