Provider Demographics
NPI:1194955021
Name:PRASAD, AMISH SHANKAR (DO)
Entity type:Individual
Prefix:
First Name:AMISH
Middle Name:SHANKAR
Last Name:PRASAD
Suffix:
Gender:M
Credentials:DO
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:2009-07-27
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101019672207R00000X
NVDO1979207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine