Provider Demographics
NPI:1841485786
Name:MOSTAFA SHETA MD LTD.
Entity type:Organization
Organization Name:MOSTAFA SHETA MD LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSTAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-604-4448
Mailing Address - Street 1:282 E LAKE MEAD PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-5582
Mailing Address - Country:US
Mailing Address - Phone:702-604-4448
Mailing Address - Fax:
Practice Address - Street 1:282 E LAKE MEAD PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5582
Practice Address - Country:US
Practice Address - Phone:702-604-4448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV35701Medicare PIN
NVF90756Medicare UPIN