Provider Demographics
NPI:1528027729
Name:SHEHATA, ADEL R (MD)
Entity Type:Individual
Prefix:
First Name:ADEL
Middle Name:R
Last Name:SHEHATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4275 BURNHAM AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5488
Mailing Address - Country:US
Mailing Address - Phone:702-734-0808
Mailing Address - Fax:702-734-2650
Practice Address - Street 1:4275 BURNHAM AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5488
Practice Address - Country:US
Practice Address - Phone:702-734-0808
Practice Address - Fax:702-734-2650
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV8985207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F83284Medicare UPIN