Healthcare Provider Details

I. General information

NPI: 1104512797
Provider Name (Legal Business Name): BRENDA SHEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11860 SOUTHERN HIGHLANDS PKWY STE 100
LAS VEGAS NV
89141-3304
US

IV. Provider business mailing address

1800 W CHARLESTON BLVD
LAS VEGAS NV
89102-2386
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-2273
  • Fax: 702-224-7180
Mailing address:
  • Phone: 702-383-2000
  • Fax: 702-383-2005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30001
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: