Provider Demographics
NPI:1194222430
Name:HARRIS, SHAILY RAVAE
Entity Type:Individual
Prefix:
First Name:SHAILY
Middle Name:RAVAE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAILY
Other - Middle Name:RAVAE
Other - Last Name:GENTILE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5761 S FORT APACHE RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5506
Mailing Address - Country:US
Mailing Address - Phone:702-341-6610
Mailing Address - Fax:702-341-6961
Practice Address - Street 1:5761 S FORT APACHE RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5506
Practice Address - Country:US
Practice Address - Phone:702-341-6610
Practice Address - Fax:702-341-6961
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV38326DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered