Provider Demographics
NPI:1104920206
Name:USEFI-MORIDANI, SHADI (APN)
Entity type:Individual
Prefix:
First Name:SHADI
Middle Name:
Last Name:USEFI-MORIDANI
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 W. CHARLESTON BLVD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146
Mailing Address - Country:US
Mailing Address - Phone:702-877-9514
Mailing Address - Fax:702-312-3510
Practice Address - Street 1:1905 CIVIC CENTER DR.
Practice Address - Street 2:
Practice Address - City:NO. LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030
Practice Address - Country:US
Practice Address - Phone:702-649-3736
Practice Address - Fax:702-312-3510
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN55045363L00000X
NVAPN000973363L00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1104920206Medicaid
NV1104920206Medicaid