Provider Demographics
NPI:1447664321
Name:SHAH, BEREN MAHESH (DPT)
Entity type:Individual
Prefix:
First Name:BEREN
Middle Name:MAHESH
Last Name:SHAH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 SKY POINTE DR STE 140-463
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-4047
Mailing Address - Country:US
Mailing Address - Phone:714-366-2777
Mailing Address - Fax:
Practice Address - Street 1:7808 HIDDEN GAZEBO ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-8251
Practice Address - Country:US
Practice Address - Phone:714-366-2777
Practice Address - Fax:714-366-2777
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist