MEDICARE: MRS. HAE RA SHIN

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	103TR0400X	Rehabilitation Psychologist

General Provider Information

NPI Number	:	1083958516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HAE RA SHIN

Provider Business Mailing Address
First Line	:	10381 CATCLAW CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2053
Country	:	US
Telephone Number	:	702-445-9128
Fax Number	:

Provider Business Practice Location Address
First Line	:	10381 CATCLAW CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-2053
Country	:	US
Telephone Number	:	702-445-9128
Fax Number	:

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

Provider Enumeration Date	:	11/21/2012
Last Update Date	:	11/21/2012

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