Provider Demographics
NPI:1710968391
Name:REID, SHAWNA RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:RAE
Last Name:REID
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1998
Mailing Address - Country:US
Mailing Address - Phone:702-476-9999
Mailing Address - Fax:702-946-1343
Practice Address - Street 1:2809 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1998
Practice Address - Country:US
Practice Address - Phone:702-476-9999
Practice Address - Fax:702-946-1343
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA734363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
V37609Medicare PIN
NVP2276Medicare UPIN