Provider Demographics
NPI:1194388439
Name:NIELSON, MICHAEL SHAY
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SHAY
Last Name:NIELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89024-0757
Mailing Address - Country:US
Mailing Address - Phone:702-346-1899
Mailing Address - Fax:702-346-8581
Practice Address - Street 1:1140 W. PIONEER BLVD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027
Practice Address - Country:US
Practice Address - Phone:702-346-1899
Practice Address - Fax:702-346-8581
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-2225225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation