Healthcare Provider Details

I. General information

NPI: 1215399514
Provider Name (Legal Business Name): BHAVANA BHAYA M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W CHARLESTON BLVD STE 230
LAS VEGAS NV
89102-2312
US

IV. Provider business mailing address

3016 W CHARLESTON BLVD STE 100
LAS VEGAS NV
89102-1973
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-2341
  • Fax:
Mailing address:
  • Phone: 702-671-2341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18676
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: