Provider Demographics
NPI:1477558674
Name:DIXIT, SHANKER N (MD)
Entity type:Individual
Prefix:
First Name:SHANKER
Middle Name:N
Last Name:DIXIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33340
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-3340
Mailing Address - Country:US
Mailing Address - Phone:702-405-3015
Mailing Address - Fax:702-405-3017
Practice Address - Street 1:2440 PROFESSIONAL CT
Practice Address - Street 2:SUITE 150
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0838
Practice Address - Country:US
Practice Address - Phone:702-405-3015
Practice Address - Fax:702-405-3017
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI385552084N0400X
NV97392084N0600X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018281Medicaid
WI32358700Medicaid