Provider Demographics
NPI:1114657434
Name:KYEBALABA, SHARKIRA
Entity Type:Individual
Prefix:
First Name:SHARKIRA
Middle Name:
Last Name:KYEBALABA
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 1:3230 SOUTH BUFFALO DRIVE
Mailing Address - Street 2:SUITE 105 UNIT 2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117
Mailing Address - Country:US
Mailing Address - Phone:702-943-8898
Mailing Address - Fax:702-944-7298
Practice Address - Street 1:3230 SOUTH BUFFALO DRIVE
Practice Address - Street 2:SUITE 105 UNIT 2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-943-8898
Practice Address - Fax:702-944-7298
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-11
Last Update Date:2022-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV201712194283747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant