Provider Demographics
NPI:1417994245
Name:SHUJA, REEM MANZOOR (MD)
Entity Type:Individual
Prefix:DR
First Name:REEM
Middle Name:MANZOOR
Last Name:SHUJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REEM
Other - Middle Name:MANZOOR
Other - Last Name:ASIF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3540 W SAHARA AVE
Mailing Address - Street 2:# 330
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-5816
Mailing Address - Country:US
Mailing Address - Phone:702-921-6823
Mailing Address - Fax:702-549-5240
Practice Address - Street 1:3540 W SAHARA AVE # 330
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-5816
Practice Address - Country:US
Practice Address - Phone:702-921-6823
Practice Address - Fax:702-549-5240
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217382207R00000X
NV16526207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV16526OtherMEDICAL LICENSE
NY2R9291Medicare ID - Type Unspecified