MEDICARE: MISS ANGELINA ABOU SHACKR ALJOT

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1427804459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANGELINA ABOU SHACKR ALJOT

Provider Business Mailing Address
First Line	:	3554 GREAT BEAR ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7721
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3554 GREAT BEAR ST
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-7721
Country	:	US
Telephone Number	:	725-300-5059
Fax Number	:

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

Provider Enumeration Date	:	04/29/2024
Last Update Date	:	03/05/2025

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