Provider Demographics
NPI:1427259209
Name:MCGIVNEY, SHAWN ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ALLEN
Last Name:MCGIVNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 S NELLIS BLVD # G3-173
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-6213
Mailing Address - Country:US
Mailing Address - Phone:775-828-9435
Mailing Address - Fax:
Practice Address - Street 1:2232 S NELLIS BLVD # G3-173
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-6213
Practice Address - Country:US
Practice Address - Phone:775-828-9435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179171207RG0300X
NV10850207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100503620Medicaid
NYF19911Medicare UPIN