Provider Demographics
NPI:1578814190
Name:KINCADE, SHADELL ANEICE
Entity Type:Individual
Prefix:MS
First Name:SHADELL
Middle Name:ANEICE
Last Name:KINCADE
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 1:4485 PENNWOOD AVE APT 182
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-7213
Mailing Address - Country:US
Mailing Address - Phone:562-206-5578
Mailing Address - Fax:
Practice Address - Street 1:4485 PENNWOOD AVE APT 182
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-7213
Practice Address - Country:US
Practice Address - Phone:562-206-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker