Provider Demographics
NPI:1881979094
Name:PAGE, SHEREE
Entity type:Individual
Prefix:
First Name:SHEREE
Middle Name:
Last Name:PAGE
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 1:1840 VERDE MIRADA DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-3843
Mailing Address - Country:US
Mailing Address - Phone:702-860-7875
Mailing Address - Fax:702-453-7243
Practice Address - Street 1:3550 W CHEYENNE AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-8252
Practice Address - Country:US
Practice Address - Phone:702-648-3913
Practice Address - Fax:702-868-8357
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst