Healthcare Provider Details

I. General information

NPI: 1063475770
Provider Name (Legal Business Name): SHAUKAT SHAMSUDIN DAMJI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6070 S FORT APACHE RD STE 100
LAS VEGAS NV
89148-5615
US

IV. Provider business mailing address

6070 S FORT APACHE RD STE 100
LAS VEGAS NV
89148-5615
US

V. Phone/Fax

Practice location:
  • Phone: 702-803-5534
  • Fax: 888-977-1206
Mailing address:
  • Phone: 702-803-5534
  • Fax: 888-977-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7362
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: