Provider Demographics
NPI:1144414053
Name:SHIGEEDA, MAIKO (ATC)
Entity Type:Individual
Prefix:
First Name:MAIKO
Middle Name:
Last Name:SHIGEEDA
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6608 BURIED TREASURE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6134
Mailing Address - Country:US
Mailing Address - Phone:507-351-1067
Mailing Address - Fax:
Practice Address - Street 1:601 WHITNEY RANCH DR
Practice Address - Street 2:SUITE B6
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2642
Practice Address - Country:US
Practice Address - Phone:702-454-1162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV05061722255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer