MEDICARE: TINA V SHAH SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	1248	NV

General Provider Information

NPI Number	:	1083938641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA V SHAH SLP

Provider Business Mailing Address
First Line	:	5167 VILLA VECCHIO CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-0461
Country	:	US
Telephone Number	:	804-332-9223
Fax Number	:

Provider Business Practice Location Address
First Line	:	5167 VILLA VECCHIO CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89141-0461
Country	:	US
Telephone Number	:	804-332-9223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2010
Last Update Date	:	03/24/2010

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Directions to “ TINA V SHAH SLP” Practice Location

Language	Start Address	Practice Location

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