Provider Demographics
NPI:1396446506
Name:MERSHA, YORDANOS
Entity type:Individual
Prefix:
First Name:YORDANOS
Middle Name:
Last Name:MERSHA
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 1:2449 N TENAYA WAY UNIT 36454
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-8140
Mailing Address - Country:US
Mailing Address - Phone:617-314-3266
Mailing Address - Fax:
Practice Address - Street 1:2700 LAS VEGAS BLVD S UNIT 3405
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1170
Practice Address - Country:US
Practice Address - Phone:702-530-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies