Healthcare Provider Details

I. General information

NPI: 1831534478
Provider Name (Legal Business Name): AVERY C ROSSIDIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 S MARYLAND PKWY
LAS VEGAS NV
89109-2317
US

IV. Provider business mailing address

653 N TOWN CENTER DR STE 412
LAS VEGAS NV
89144-0518
US

V. Phone/Fax

Practice location:
  • Phone: 702-961-5000
  • Fax:
Mailing address:
  • Phone: 702-233-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number22037
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: