Healthcare Provider Details

I. General information

NPI: 1871519041
Provider Name (Legal Business Name): MUJEEB UDDIN SHAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 S RAINBOW BLVD
LAS VEGAS NV
89118-1859
US

IV. Provider business mailing address

10624 S EASTERN AVE STE A-955
HENDERSON NV
89052-2982
US

V. Phone/Fax

Practice location:
  • Phone: 702-853-3000
  • Fax: 702-385-3073
Mailing address:
  • Phone:
  • Fax: 24-077-0167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number20009
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036-132238
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20009
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: