MEDICARE: ROSHONDA JANEANE MAYFIELD

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	253Z00000X	In Home Supportive Care Agency	NV20212085386	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861026403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSHONDA JANEANE MAYFIELD

Provider Business Mailing Address
First Line	:	PO BOX 572237
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89157-2237
Country	:	US
Telephone Number	:	702-808-2656
Fax Number	:	702-478-6932

Provider Business Practice Location Address
First Line	:	2675 NORTH DECATUR BOULEVARD
Second Line	:	#572237
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-8910
Country	:	US
Telephone Number	:	702-808-2565
Fax Number	:	702-478-6932

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

Provider Enumeration Date	:	02/22/2020
Last Update Date	:	05/19/2021

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Directions to “ ROSHONDA JANEANE MAYFIELD ” Practice Location

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