Provider Demographics
NPI:1104815463
Name:CHOWDHRY, SHAHEEN NOOR (MD)
Entity type:Individual
Prefix:MISS
First Name:SHAHEEN
Middle Name:NOOR
Last Name:CHOWDHRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 N TENAYA WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0488
Mailing Address - Country:US
Mailing Address - Phone:702-805-5678
Mailing Address - Fax:
Practice Address - Street 1:2911 N TENAYA WAY STE 104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0488
Practice Address - Country:US
Practice Address - Phone:702-805-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9117174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1104815463Medicaid
NVGE612YMedicare PIN
NV1104815463Medicaid
NVG37273Medicare UPIN