Provider Demographics
NPI:1073072633
Name:WEATHERSPOON, SYLVANA
Entity Type:Individual
Prefix:
First Name:SYLVANA
Middle Name:
Last Name:WEATHERSPOON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 N NELLIS BLVD APT 1068
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-2478
Mailing Address - Country:US
Mailing Address - Phone:928-955-1625
Mailing Address - Fax:
Practice Address - Street 1:3175 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3308
Practice Address - Country:US
Practice Address - Phone:702-320-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant