Provider Demographics
NPI:1306415740
Name:WINSTON, SHANETHIA DANYELLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SHANETHIA
Middle Name:DANYELLE
Last Name:WINSTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 KAREN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1264
Mailing Address - Country:US
Mailing Address - Phone:702-416-0553
Mailing Address - Fax:
Practice Address - Street 1:900 KAREN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1264
Practice Address - Country:US
Practice Address - Phone:702-416-0553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner