Provider Demographics
NPI:1124593546
Name:SHAMSUD-DIN, AYASHA
Entity Type:Individual
Prefix:
First Name:AYASHA
Middle Name:
Last Name:SHAMSUD-DIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E DESERT INN RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-3242
Mailing Address - Country:US
Mailing Address - Phone:503-560-9252
Mailing Address - Fax:702-442-8469
Practice Address - Street 1:1700 E DESERT INN RD STE 304B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-3207
Practice Address - Country:US
Practice Address - Phone:503-560-9252
Practice Address - Fax:702-442-8469
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health