Provider Demographics
NPI:1376054288
Name:DAVIS, SHAYNE
Entity Type:Individual
Prefix:
First Name:SHAYNE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3258 BUNKER HILL LN
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-1150
Mailing Address - Country:US
Mailing Address - Phone:775-379-0954
Mailing Address - Fax:
Practice Address - Street 1:7168 CREST HILL DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-5634
Practice Address - Country:US
Practice Address - Phone:775-360-6294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health