Provider Demographics
NPI:1013277599
Name:STEWARD, SHANYCE LAVONNE
Entity Type:Individual
Prefix:
First Name:SHANYCE
Middle Name:LAVONNE
Last Name:STEWARD
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 1:675 E. AZURE AVE
Mailing Address - Street 2:UNIT 2035
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081
Mailing Address - Country:US
Mailing Address - Phone:702-331-6178
Mailing Address - Fax:
Practice Address - Street 1:3320 SUNRISE AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-4864
Practice Address - Country:US
Practice Address - Phone:702-445-6594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X, 251B00000X, 251S00000X, 253J00000X
NV253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health