MEDICARE: SHALEV & ASSOCIATES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	0304	NV

General Provider Information

NPI Number	:	1104107028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHALEV & ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	3213 VILLA PISANI CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-7267
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3213 VILLA PISANI CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-7267
Country	:	US
Telephone Number	:	702-379-3880
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. AMIR SHALEV
Credential	:	DPM
Telephone Number	:	702-379-3880

Provider Enumeration Date	:	09/06/2011
Last Update Date	:	09/06/2011

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