Provider Demographics
NPI:1013047091
Name:SHIODE, DANIEL T (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:T
Last Name:SHIODE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S RANCHO DR
Mailing Address - Street 2:STE I-64
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4828
Mailing Address - Country:US
Mailing Address - Phone:702-384-4110
Mailing Address - Fax:702-384-7954
Practice Address - Street 1:501 S RANCHO DR
Practice Address - Street 2:STE I-64
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-384-4110
Practice Address - Fax:702-384-7954
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0244103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002602062Medicaid
NV002602062Medicaid