Healthcare Provider Details

I. General information

NPI: 1891172441
Provider Name (Legal Business Name): SHAIN HOWARD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7455 W WASHINGTON AVE STE 160
LAS VEGAS NV
89128-4356
US

IV. Provider business mailing address

7455 W WASHINGTON AVE STE 160
LAS VEGAS NV
89128-4356
US

V. Phone/Fax

Practice location:
  • Phone: 702-878-0393
  • Fax: 702-258-3777
Mailing address:
  • Phone: 702-878-0393
  • Fax: 702-258-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberSL1069
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberDO2916
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDO2916
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: