Provider Demographics
NPI:1366899023
Name:BIRDSONG, DONEISHA
Entity type:Individual
Prefix:
First Name:DONEISHA
Middle Name:
Last Name:BIRDSONG
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 1:3940 N MLK BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-6607
Mailing Address - Country:US
Mailing Address - Phone:702-476-5058
Mailing Address - Fax:702-476-5125
Practice Address - Street 1:3925 W CHEYENNE AVE STE 401
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-3495
Practice Address - Country:US
Practice Address - Phone:702-868-2901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2022-04-13
Deactivation Date:2018-04-17
Deactivation Code:
Reactivation Date:2018-06-05
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst