Provider Demographics
NPI:1891383964
Name:HARVEY, SHANGO STEFAN
Entity Type:Individual
Prefix:
First Name:SHANGO
Middle Name:STEFAN
Last Name:HARVEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 LAKERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-7603
Mailing Address - Country:US
Mailing Address - Phone:313-254-8268
Mailing Address - Fax:
Practice Address - Street 1:550 W PIONEER BLVD STE 204
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-1406
Practice Address - Country:US
Practice Address - Phone:702-345-4065
Practice Address - Fax:702-345-4077
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker