Provider Demographics
NPI:1619757895
Name:LEWIS, SHANNON YVETTE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:YVETTE
Last Name:LEWIS
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 1:3531 E RUSSELL RD STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2246
Mailing Address - Country:US
Mailing Address - Phone:702-547-9819
Mailing Address - Fax:
Practice Address - Street 1:3531 E RUSSELL RD STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2246
Practice Address - Country:US
Practice Address - Phone:702-547-9819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician