Provider Demographics
NPI:1144779448
Name:SMITH, SHELDON
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 W SAHARA AVE
Mailing Address - Street 2:#101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0394
Mailing Address - Country:US
Mailing Address - Phone:702-882-7827
Mailing Address - Fax:
Practice Address - Street 1:5420 W SAHARA AVE
Practice Address - Street 2:#101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0394
Practice Address - Country:US
Practice Address - Phone:702-882-7827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner