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General NPI Number Information
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NPI Number | 1174970883
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Entity Type | Individual
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Provider Name | SHAILENDRA JAIN CNP
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Gender | Male
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 6855 W CHARLESTON BLVD STE A
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City | LAS VEGAS
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State | NV
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Zip | 89117-1675
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Country | US
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Telephone | 725-205-3557
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Fax | 866-531-4145
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Provider Business Mailing Address
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Address Line | 4310 METRO PKWY STE 205
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City | FORT MYERS
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State | FL
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Zip | 33916-9416
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Country | US
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Telephone | 239-236-8784
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Fax | 239-790-2624
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN9485699
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 832251
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | COA.19140-NP
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License Number State | OH
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