Healthcare Provider Details

I. General information

NPI: 1396485330
Provider Name (Legal Business Name): SHAH HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 W HORIZON RIDGE PKWY STE 100
HENDERSON NV
89052-2870
US

IV. Provider business mailing address

PO BOX 36830
LAS VEGAS NV
89133-6830
US

V. Phone/Fax

Practice location:
  • Phone: 702-578-5737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DHAVAL SHAH
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 702-578-5737