Provider Demographics
NPI:1558601005
Name:WALKER, SHAKONDA SHERIEE
Entity Type:Individual
Prefix:MS
First Name:SHAKONDA
Middle Name:SHERIEE
Last Name:WALKER
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 1:3631 RUSSIAN OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-7647
Mailing Address - Country:US
Mailing Address - Phone:702-581-4309
Mailing Address - Fax:
Practice Address - Street 1:1333 N BUFFALO DR
Practice Address - Street 2:SUITE 250
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-3636
Practice Address - Country:US
Practice Address - Phone:702-354-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV20111675665Medicaid