Provider Demographics
NPI:1083639603
Name:SHUJA, AMIR (MD)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:SHUJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 SKYBIRD CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-7865
Mailing Address - Country:US
Mailing Address - Phone:702-921-6823
Mailing Address - Fax:702-549-5240
Practice Address - Street 1:47 SKYBIRD CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-7865
Practice Address - Country:US
Practice Address - Phone:702-921-6823
Practice Address - Fax:702-549-5240
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9948207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018466Medicaid
NV002018466Medicaid
H45514Medicare UPIN