Provider Demographics
NPI:1699469908
Name:HEFFNER, SHACONDALA
Entity type:Individual
Prefix:
First Name:SHACONDALA
Middle Name:
Last Name:HEFFNER
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 1:2375 E TROPICANA AVE # 8207
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6564
Mailing Address - Country:US
Mailing Address - Phone:708-655-7756
Mailing Address - Fax:
Practice Address - Street 1:5045 HARRISON DR APT 129
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-1087
Practice Address - Country:US
Practice Address - Phone:708-655-7756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty