Provider Demographics
NPI:1225299431
Name:FAIRLEY, JEMILA MERSHEA (AUD)
Entity Type:Individual
Prefix:DR
First Name:JEMILA
Middle Name:MERSHEA
Last Name:FAIRLEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W CHARLESTON BLVD
Mailing Address - Street 2:#215
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2325
Mailing Address - Country:US
Mailing Address - Phone:702-671-2395
Mailing Address - Fax:702-382-5388
Practice Address - Street 1:5380 S RAINBOW BLVD
Practice Address - Street 2:STE. 324
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1877
Practice Address - Country:US
Practice Address - Phone:702-734-3606
Practice Address - Fax:702-992-6820
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-209231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist