Provider Demographics
NPI:1053583922
Name:ROSHAN, SHAMEYEL (DO)
Entity type:Individual
Prefix:
First Name:SHAMEYEL
Middle Name:
Last Name:ROSHAN
Suffix:
Gender:F
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:PO BOX 530815
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-0815
Mailing Address - Country:US
Mailing Address - Phone:702-487-7055
Mailing Address - Fax:702-991-7258
Practice Address - Street 1:3001 SAINT ROSE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3839
Practice Address - Country:US
Practice Address - Phone:702-487-7055
Practice Address - Fax:702-991-7258
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1460207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine