Provider Demographics
NPI:1619223278
Name:CHANEY, SHAUNICIA LATRICE
Entity Type:Individual
Prefix:
First Name:SHAUNICIA
Middle Name:LATRICE
Last Name:CHANEY
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 1:5325 WILD SUNFLOWER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-4038
Mailing Address - Country:US
Mailing Address - Phone:702-272-6485
Mailing Address - Fax:
Practice Address - Street 1:5325 WILD SUNFLOWER ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-4038
Practice Address - Country:US
Practice Address - Phone:702-272-6485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner