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NPI Code Detail

MEDICARE: SHANAE VIZZA PA-C

MEDICARE: SHANAE VIZZA PA-C
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
1363AS0400XSurgical Physician AssistantPA2563NV
2363A00000XPhysician AssistantPA2563NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2V71859OTHERNVMEDICARE NV

Other Identifiers

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

General Provider Information

NPI Number : 1457920076
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANAE VIZZA PA-C
Provider Business Mailing Address
First Line : 5310 KIETZKE LN STE 104
Second Line :
City : RENO
State : NV
Zip : 89511-2043
Country : US
Telephone Number : 775-348-8800
Fax Number : 833-687-1419
Provider Business Practice Location Address
First Line : 9480 DOUBLE DIAMOND PKWY STE 200
Second Line :
City : RENO
State : NV
Zip : 89521-5842
Country : US
Telephone Number : 775-348-8800
Fax Number : 833-687-1419
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2021
Last Update Date : 04/22/2026

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Directions to “ SHANAE VIZZA PA-C” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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