Provider Demographics
NPI:1295606358
Name:BRANDON, SHAWNTERIA M
Entity type:Individual
Prefix:
First Name:SHAWNTERIA
Middle Name:M
Last Name:BRANDON
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 1:905 BRIDGEWATER ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-5731
Mailing Address - Country:US
Mailing Address - Phone:702-766-9840
Mailing Address - Fax:
Practice Address - Street 1:905 BRIDGEWATER ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-5731
Practice Address - Country:US
Practice Address - Phone:702-766-9840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-12
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-25-46431106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician