Healthcare Provider Details

I. General information

NPI: 1235065426
Provider Name (Legal Business Name): DR. SHAYAN HERVANI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E CARSON AVE FL 10
LAS VEGAS NV
89101-5905
US

IV. Provider business mailing address

302 E CARSON AVE FL 10
LAS VEGAS NV
89101-5905
US

V. Phone/Fax

Practice location:
  • Phone: 678-429-1397
  • Fax:
Mailing address:
  • Phone: 678-429-1397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8371
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: