Provider Demographics
NPI:1417689696
Name:FIORI, SHARK M
Entity Type:Individual
Prefix:
First Name:SHARK
Middle Name:M
Last Name:FIORI
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 1:3930 HOWARD HUGHES PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-0946
Mailing Address - Country:US
Mailing Address - Phone:702-789-5901
Mailing Address - Fax:866-241-4406
Practice Address - Street 1:3930 HOWARD HUGHES PKWY STE 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-0946
Practice Address - Country:US
Practice Address - Phone:702-789-5901
Practice Address - Fax:866-241-4406
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-23-64073103K00000X
106S00000X
NV1-23-64073103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician