Provider Demographics
NPI:1477714574
Name:SHAH, MANE (MD)
Entity type:Individual
Prefix:
First Name:MANE
Middle Name:
Last Name:SHAH
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 1:2901 N TENAYA WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1420
Mailing Address - Country:US
Mailing Address - Phone:702-852-2000
Mailing Address - Fax:702-821-1704
Practice Address - Street 1:2901 N TENAYA WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1420
Practice Address - Country:US
Practice Address - Phone:702-852-2000
Practice Address - Fax:702-821-1704
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12786207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist