Provider Demographics
NPI:1265821813
Name:DAVIS, SHACORA
Entity Type:Individual
Prefix:
First Name:SHACORA
Middle Name:
Last Name:DAVIS
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 1:8000 SPRING MOUNTAIN RD
Mailing Address - Street 2:APT 2062
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3908
Mailing Address - Country:US
Mailing Address - Phone:702-510-6209
Mailing Address - Fax:
Practice Address - Street 1:8000 SPRING MOUNTAIN RD
Practice Address - Street 2:APT 2062
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3908
Practice Address - Country:US
Practice Address - Phone:702-510-6209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst