MEDICARE: AMISH SHANKAR PRASAD DO

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	207R00000X	Internal Medicine Physician	5101019672	MI
2	207RC0000X	Cardiovascular Disease Physician	DO1979	NV

General Provider Information

NPI Number	:	1194955021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMISH SHANKAR PRASAD DO

Provider Business Mailing Address
First Line	:	2911 N TENAYA WAY STE 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0488
Country	:	US
Telephone Number	:	702-805-5678
Fax Number	:

Provider Business Practice Location Address
First Line	:	2911 N TENAYA WAY STE 104
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0488
Country	:	US
Telephone Number	:	702-805-5678
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2009
Last Update Date	:	11/25/2020

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Directions to “ AMISH SHANKAR PRASAD DO” Practice Location

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