Provider Demographics
NPI:1255811683
Name:ANIFOWOSHE, SHAKEEMIA SHAMEECE
Entity type:Individual
Prefix:
First Name:SHAKEEMIA
Middle Name:SHAMEECE
Last Name:ANIFOWOSHE
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 1:4832 MAHOGANY DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-4734
Mailing Address - Country:US
Mailing Address - Phone:702-945-4366
Mailing Address - Fax:
Practice Address - Street 1:5552 MESQUITE CREEK ST
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-6835
Practice Address - Country:US
Practice Address - Phone:702-703-9788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialist
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No376J00000XNursing Service Related ProvidersHomemaker