Provider Demographics
NPI:1770659575
Name:STEIN, SHELDON JACK (DO)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:JACK
Last Name:STEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10404 AMERICAN FALLS LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-1376
Mailing Address - Country:US
Mailing Address - Phone:702-254-4770
Mailing Address - Fax:
Practice Address - Street 1:900 OWENS AVE.
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-636-6380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV864207Q00000X
MI5101005787207Q00000X
MODO31497207Q00000X
FLOS2949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVE12037Medicare UPIN