Provider Demographics
NPI:1356638811
Name:SHAMLOO, MEHDI (MD)
Entity Type:Individual
Prefix:
First Name:MEHDI
Middle Name:
Last Name:SHAMLOO
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 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-671-6883
Practice Address - Street 1:9499 W CHARLESTON BLVD STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7147
Practice Address - Country:US
Practice Address - Phone:702-228-5477
Practice Address - Fax:702-255-7981
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01077867A207Q00000X
390200000X
NV19520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV19520OtherSTATE LICENSE
IN300002768Medicaid
NV1356638811Medicaid