MEDICARE: DR. ALI SHEHATA 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	207Q00000X	Family Medicine Physician	0639	SC
2	207Q00000X	Family Medicine Physician	DO2829	NV

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
2	DO2829	OTHER	NV	STATE LICENSE

General Provider Information

NPI Number	:	1205997665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALI SHEHATA D.O.

Provider Business Mailing Address
First Line	:	6355 S BUFFALO DR FL 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2133
Country	:	US
Telephone Number	:	702-216-3346
Fax Number	:	702-671-6883

Provider Business Practice Location Address
First Line	:	4275 BURNHAM AVE STE 340
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-5400
Country	:	US
Telephone Number	:	702-734-6363
Fax Number	:	702-734-6374

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	10/20/2022

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Directions to “ DR. ALI SHEHATA D.O.” Practice Location

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