Provider Demographics
NPI:1659987378
Name:NEAL, SHAYLENA MARIE
Entity Type:Individual
Prefix:
First Name:SHAYLENA
Middle Name:MARIE
Last Name:NEAL
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 1:725 LILLY LN # 17C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-2867
Mailing Address - Country:US
Mailing Address - Phone:702-665-3300
Mailing Address - Fax:
Practice Address - Street 1:3301 SPRING MOUNTAIN RD STE 16
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8649
Practice Address - Country:US
Practice Address - Phone:702-362-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant