Provider Demographics
NPI:1376026476
Name:CHERRY, DANIELLE SHAWTELLE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:SHAWTELLE
Last Name:CHERRY
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 1:4187 S PECOS RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5023
Mailing Address - Country:US
Mailing Address - Phone:702-486-7529
Mailing Address - Fax:
Practice Address - Street 1:4187 S PECOS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5023
Practice Address - Country:US
Practice Address - Phone:702-486-7529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator