Provider Demographics
NPI:1174824965
Name:SWINTON, SHAMICE
Entity Type:Individual
Prefix:
First Name:SHAMICE
Middle Name:
Last Name:SWINTON
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 1:4051 W VIKING RD
Mailing Address - Street 2:APT 68
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-6004
Mailing Address - Country:US
Mailing Address - Phone:856-503-7706
Mailing Address - Fax:
Practice Address - Street 1:4051 W VIKING RD
Practice Address - Street 2:APT 68
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-6004
Practice Address - Country:US
Practice Address - Phone:856-503-7706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst