Provider Demographics
NPI:1679902852
Name:ABEYTA, SHELBY ALISE
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:ALISE
Last Name:ABEYTA
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 1:1132 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-6116
Mailing Address - Country:US
Mailing Address - Phone:775-720-1451
Mailing Address - Fax:
Practice Address - Street 1:1132 FREMONT ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-6116
Practice Address - Country:US
Practice Address - Phone:775-720-1451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation