Healthcare Provider Details

I. General information

NPI: 1699739151
Provider Name (Legal Business Name): SHADI N DAOUD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 N TENAYA WAY STE 100
LAS VEGAS NV
89128-0642
US

IV. Provider business mailing address

2880 N TENAYA WAY STE 100
LAS VEGAS NV
89128-0642
US

V. Phone/Fax

Practice location:
  • Phone: 702-962-2200
  • Fax:
Mailing address:
  • Phone: 702-962-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-083390
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number12536
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number12536
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: