Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013312404 |
---|---|
Provider Name | Sheldy Johana Santos |
First Address | Las Vegas, NV 89104-1705 |
Second Address | Las Vegas, NV 89104-1705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2014 |
Last Update Date | 28/10/2014 |