Provider Demographics
NPI:1053008342
Name:STEWART-ROBINSON, SHANICE MONIQUE
Entity type:Individual
Prefix:
First Name:SHANICE
Middle Name:MONIQUE
Last Name:STEWART-ROBINSON
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 1:1416 DOUCETTE DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-7915
Mailing Address - Country:US
Mailing Address - Phone:702-801-8248
Mailing Address - Fax:
Practice Address - Street 1:1416 DOUCETTE DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142-7915
Practice Address - Country:US
Practice Address - Phone:702-801-8248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty