Provider Demographics
NPI:1396230165
Name:MCCALLA, SHELANDO ALECIA
Entity Type:Individual
Prefix:
First Name:SHELANDO
Middle Name:ALECIA
Last Name:MCCALLA
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 1:7771 GREENLAKE WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-6616
Mailing Address - Country:US
Mailing Address - Phone:702-704-9747
Mailing Address - Fax:
Practice Address - Street 1:7771 GREENLAKE WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-6616
Practice Address - Country:US
Practice Address - Phone:702-704-9747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner