MEDICARE: DR. HIMANSU R SHAH M.D.

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	NV 10134	NV
2	208200000X	Plastic Surgery Physician	NV10134	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CS11151	OTHER	NV	PHARMACY/CDS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417935065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HIMANSU R SHAH M.D.

Provider Business Mailing Address
First Line	:	3035 W HORIZON RIDGE PKWY
Second Line	:	# 100
City	:	HENDERSON
State	:	NV
Zip	:	89052-4188
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	:	SUITE 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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	03/07/2023

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