Provider Demographics
NPI:1417935065
Name:SHAH, HIMANSU R (MD)
Entity Type:Individual
Prefix:DR
First Name:HIMANSU
Middle Name:R
Last Name:SHAH
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 1:3035 W HORIZON RIDGE PKWY
Mailing Address - Street 2:# 100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4188
Mailing Address - Country:US
Mailing Address - Phone:702-684-5502
Mailing Address - Fax:702-684-5503
Practice Address - Street 1:3035 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4188
Practice Address - Country:US
Practice Address - Phone:702-684-5502
Practice Address - Fax:702-684-5503
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV 101342082S0105X
NVNV10134208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCS11151OtherPHARMACY/CDS
NV002018548Medicaid
NVBS4703321OtherDEA
NVG21421Medicare UPIN
NVWQBHV36328Medicare ID - Type Unspecified