Provider Demographics
NPI:1043517964
Name:GUILLORY, SHALONDA (BA)
Entity type:Individual
Prefix:MRS
First Name:SHALONDA
Middle Name:
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6260 W COUGAR AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6861
Mailing Address - Country:US
Mailing Address - Phone:702-415-3052
Mailing Address - Fax:
Practice Address - Street 1:6260 W COUGAR AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-6861
Practice Address - Country:US
Practice Address - Phone:702-415-3052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No104100000XBehavioral Health & Social Service ProvidersSocial Worker