Provider Demographics
NPI:1881026268
Name:SCHILLER, SANDRA NICOLE
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:NICOLE
Last Name:SCHILLER
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 1:6885 W LONE MOUNTAIN RD
Mailing Address - Street 2:APT. 358
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-5800
Mailing Address - Country:US
Mailing Address - Phone:702-785-4837
Mailing Address - Fax:
Practice Address - Street 1:4130 MARTIN LUTHER KING BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:N. LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-802-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV$$$$$$$$$Medicaid