Provider Demographics
NPI:1689436719
Name:SHAHEN, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SHAHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7574 CAMINO HEIGHTS CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-5328
Mailing Address - Country:US
Mailing Address - Phone:702-832-8003
Mailing Address - Fax:
Practice Address - Street 1:3400 W DESERT INN RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-8354
Practice Address - Country:US
Practice Address - Phone:702-279-4108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant