Provider Demographics
NPI:1366082471
Name:ALEXANDER, SHANISE MARIE
Entity type:Individual
Prefix:
First Name:SHANISE
Middle Name:MARIE
Last Name:ALEXANDER
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 1:510 S 10TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-7044
Mailing Address - Country:US
Mailing Address - Phone:702-462-6630
Mailing Address - Fax:
Practice Address - Street 1:510 S 10TH ST APT A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-7044
Practice Address - Country:US
Practice Address - Phone:702-462-6630
Practice Address - Fax:702-462-6634
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health