Healthcare Provider Details

I. General information

NPI: 1821904343
Provider Name (Legal Business Name): SHOTWELL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8965 S EASTERN AVE STE 110
LAS VEGAS NV
89123-4892
US

IV. Provider business mailing address

PO BOX 50006
DENTON TX
76206-0006
US

V. Phone/Fax

Practice location:
  • Phone: 844-409-4657
  • Fax: 214-614-4277
Mailing address:
  • Phone: 844-409-4657
  • Fax: 214-614-4277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA MANUEL
Title or Position: DIRECTOR OF PATIENT ADVOCACY
Credential:
Phone: 844-409-4657