MEDICARE: SHATEAA CATRICE PERRY

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1669987632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHATEAA CATRICE PERRY

Provider Business Mailing Address
First Line	:	2327 VIVA CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-3360
Country	:	US
Telephone Number	:	702-964-5693
Fax Number	:

Provider Business Practice Location Address
First Line	:	2327 VIVA CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-8910
Country	:	US
Telephone Number	:	702-964-5693
Fax Number	:

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

Provider Enumeration Date	:	12/12/2017
Last Update Date	:	12/12/2017

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Directions to “ SHATEAA CATRICE PERRY ” Practice Location

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