Provider Demographics
NPI:1447652326
Name:TALIAFERRO, SHAAESTA
Entity type:Individual
Prefix:
First Name:SHAAESTA
Middle Name:
Last Name:TALIAFERRO
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 1:7255 W SUNSET RD APT 2052
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1911
Mailing Address - Country:US
Mailing Address - Phone:786-400-9777
Mailing Address - Fax:
Practice Address - Street 1:7548 W SAHARA AVE STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2779
Practice Address - Country:US
Practice Address - Phone:702-823-2313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst