Provider Demographics
NPI:1164450524
Name:VITALE, DANA SHAWN (DO)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:SHAWN
Last Name:VITALE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:SEAN
Other - Middle Name:
Other - Last Name:VITALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:985 CANDY TUFT DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-3002
Mailing Address - Country:US
Mailing Address - Phone:928-897-2016
Mailing Address - Fax:
Practice Address - Street 1:6900 N PECOS RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:702-791-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11719207P00000X
AZ4124207Q00000X, 207P00000X
390200000X
NVDO1678207P00000X
MS21883207P00000X
GA067626207P00000X
ALDO1275204R00000X
OK5514207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ971649Medicaid
AZ971649Medicaid