Provider Demographics
NPI:1437859394
Name:REDD, FALLYAN
Entity Type:Individual
Prefix:
First Name:FALLYAN
Middle Name:
Last Name:REDD
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 1:9135 W DESERT INN RD APT G206
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-6368
Mailing Address - Country:US
Mailing Address - Phone:410-501-4752
Mailing Address - Fax:
Practice Address - Street 1:8879 W FLAMINGO RD STE 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-8733
Practice Address - Country:US
Practice Address - Phone:702-646-1150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker