Provider Demographics
NPI:1407636913
Name:PRYOR, SHAWNEA L
Entity Type:Individual
Prefix:
First Name:SHAWNEA
Middle Name:L
Last Name:PRYOR
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 1:1605 PEYTON STEWART CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-1378
Mailing Address - Country:US
Mailing Address - Phone:702-591-3346
Mailing Address - Fax:
Practice Address - Street 1:1605 PEYTON STEWART CT
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-1378
Practice Address - Country:US
Practice Address - Phone:702-591-3346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver