Healthcare Provider Details

I. General information

NPI: 1972448926
Provider Name (Legal Business Name): SALLY SAMY KAMEL KIROLLOS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 NEVADA BLAZE AVE
NORTH LAS VEGAS NV
89081-6721
US

IV. Provider business mailing address

1121 NEVADA BLAZE AVE
NORTH LAS VEGAS NV
89081-6721
US

V. Phone/Fax

Practice location:
  • Phone: 702-717-1580
  • Fax:
Mailing address:
  • Phone: 702-717-1580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number877251
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: