Provider Demographics
NPI:1104163567
Name:FINLEY, SHAVONTA R
Entity type:Individual
Prefix:
First Name:SHAVONTA
Middle Name:R
Last Name:FINLEY
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 1:4515 LAS VEGAS BLVD N UNIT 1009
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-1515
Mailing Address - Country:US
Mailing Address - Phone:702-479-9569
Mailing Address - Fax:
Practice Address - Street 1:4515 LAS VEGAS BLVD N UNIT 1009
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-1515
Practice Address - Country:US
Practice Address - Phone:702-479-9569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst