MEDICARE: BOUTHAINA SHEHAB RD, LD

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	133V00000X	Registered Dietitian	40175-DI-0	NV

General Provider Information

NPI Number	:	1962102897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOUTHAINA SHEHAB RD, LD

Provider Business Mailing Address
First Line	:	3430 E FLAMINGO RD STE 234
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5065
Country	:	US
Telephone Number	:	702-382-8841
Fax Number	:	702-382-8841

Provider Business Practice Location Address
First Line	:	3430 E FLAMINGO RD STE 234
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5065
Country	:	US
Telephone Number	:	702-382-8841
Fax Number	:	702-382-8841

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

Provider Enumeration Date	:	03/08/2023
Last Update Date	:	03/08/2023

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