Basic Information
| Provider Information | |||||||||
| NPI: | 1720477755 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BANKS-MADDOX | ||||||||
| FirstName: | SHERILL | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1058 W. OWENS AVE | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027497444 | ||||||||
| FaxNumber: | 7027497844 | ||||||||
| Practice Location | |||||||||
| Address1: | 431 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891016915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027625633 | ||||||||
| FaxNumber: | 7027497844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2015 | ||||||||
| LastUpdateDate: | 04/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 172V00000X | Y | Other Service Providers | Community Health Worker |
ID Information
| ID | Type | State | Issuer | Description | 1720477755 | 05 | NV | MEDICAID |