Provider Demographics
NPI:1982659199
Name:WIJESINGHE, HIRAN SHAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:HIRAN
Middle Name:SHAWN
Last Name:WIJESINGHE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:WIJESINGHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2441 W HORIZON RIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5789
Mailing Address - Country:US
Mailing Address - Phone:702-812-3818
Mailing Address - Fax:702-478-5465
Practice Address - Street 1:6900 N PECOS RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:702-791-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51784207P00000X
NV9446207PE0004X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C517840OtherCALOPTIMA
CA00C517840OtherBLUE SHIELD
CA00C517840Medicaid
CA050618CH06014OtherBEAR VALLEY TRAILBLAZER
CAC51784OtherBLUE CROSS
CA050618CH06014OtherBEAR VALLEY TRAILBLAZER
CAC51784OtherBLUE CROSS