Provider Demographics
NPI:1497064588
Name:DEVILLE, SABRINA DANEEN
Entity Type:Individual
Prefix:MRS
First Name:SABRINA
Middle Name:DANEEN
Last Name:DEVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SABRINA
Other - Middle Name:DANEEN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8070 W RUSSELL RD
Mailing Address - Street 2:2007
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1549
Mailing Address - Country:US
Mailing Address - Phone:951-552-5254
Mailing Address - Fax:
Practice Address - Street 1:8070 W RUSSELL RD
Practice Address - Street 2:2007
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1549
Practice Address - Country:US
Practice Address - Phone:951-552-5254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner