Healthcare Provider Details

I. General information

NPI: 1538913801
Provider Name (Legal Business Name): SHAWN CUDWORTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 E FLAMINGO RD
LAS VEGAS NV
89119-5188
US

IV. Provider business mailing address

2075 E FLAMINGO RD
LAS VEGAS NV
89119-5188
US

V. Phone/Fax

Practice location:
  • Phone: 702-388-4888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: