Provider Demographics
NPI:1144082637
Name:PERRY, SHAYNE NAASIRA
Entity type:Individual
Prefix:
First Name:SHAYNE
Middle Name:NAASIRA
Last Name:PERRY
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 1:5340 VISTA HERMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4095
Mailing Address - Country:US
Mailing Address - Phone:310-980-6544
Mailing Address - Fax:
Practice Address - Street 1:5507 W CHEYENNE AVE UNIT 5541-A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4765
Practice Address - Country:US
Practice Address - Phone:310-980-6544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant