Provider Demographics
NPI:1023188125
Name:SHAH, DIPTI R (MD)
Entity Type:Individual
Prefix:
First Name:DIPTI
Middle Name:R
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10624 S EASTERN AVE STE A-425
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2982
Mailing Address - Country:US
Mailing Address - Phone:702-644-0500
Mailing Address - Fax:702-641-4600
Practice Address - Street 1:2628 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2176
Practice Address - Country:US
Practice Address - Phone:702-644-0500
Practice Address - Fax:702-641-4600
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA068874207RN0300X
NV12211207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0090830Medicaid
H10906Medicare UPIN
CAW15322Medicare ID - Type Unspecified
NVV105028Medicare PIN