MEDICARE: HIMANSU SHAH, MD, PLLC

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	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	10134	NV
2	208200000X	Plastic Surgery Physician	10134	NV

General Provider Information

NPI Number	:	1295986156
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIMANSU SHAH, MD, PLLC

Provider Business Mailing Address
First Line	:	2508 SKIPPERS COVE AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-5607
Country	:	US
Telephone Number	:	702-684-5502
Fax Number	:	702-684-5503

Provider Business Practice Location Address
First Line	:	3035 W HORIZON RIDGE PKWY
Second Line	:	STE. 100
City	:	HENDERSON
State	:	NV
Zip	:	89052-4188
Country	:	US
Telephone Number	:	702-684-5502
Fax Number	:	702-684-5503

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. HIMANSU SHAH
Credential	:	MD
Telephone Number	:	702-684-5502

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	10/09/2008

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