Healthcare Provider Details

I. General information

NPI: 1629206404
Provider Name (Legal Business Name): ROSHAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 SAINT ROSE PKWY
HENDERSON NV
89052-3839
US

IV. Provider business mailing address

PO BOX 36830
LAS VEGAS NV
89133-6830
US

V. Phone/Fax

Practice location:
  • Phone: 702-487-7055
  • Fax: 702-991-7258
Mailing address:
  • Phone: 702-427-2166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO1460
License Number StateNV

VIII. Authorized Official

Name: SHAMEYEL ROSHAN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 702-427-2166