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1164450524

NPI Code Detail

MEDICARE: DR. DANA SHAWN VITALE D.O.

MEDICARE: DR. DANA SHAWN VITALE D.O.

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	207P00000X	Emergency Medicine Physician	OS11719	FL
2	207Q00000X	Family Medicine Physician	4124	AZ
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207P00000X	Emergency Medicine Physician	DO1678	NV
5	207P00000X	Emergency Medicine Physician	21883	MS
6	207P00000X	Emergency Medicine Physician	067626	GA
7	207P00000X	Emergency Medicine Physician	4124	AZ
8	204R00000X	Electrodiagnostic Medicine Physician	DO1275	AL
9	207P00000X	Emergency Medicine Physician	5514	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164450524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANA SHAWN VITALE D.O.

Provider Business Mailing Address
First Line	:	985 CANDY TUFT DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89011-3002
Country	:	US
Telephone Number	:	928-897-2016
Fax Number	:

Provider Business Practice Location Address
First Line	:	6900 N PECOS RD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-4400
Country	:	US
Telephone Number	:	702-791-9000
Fax Number	:

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	07/24/2025

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Directions to “ DR. DANA SHAWN VITALE D.O.” Practice Location

Language	Start Address	Practice Location

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