Provider Demographics
NPI:1447746623
Name:HERAYPUR, SHEILA (DMD)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:
Last Name:HERAYPUR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11396 RANCHO PORTENA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-1524
Mailing Address - Country:US
Mailing Address - Phone:702-875-1392
Mailing Address - Fax:
Practice Address - Street 1:8525 BLUE DIAMOND ROAD
Practice Address - Street 2:STE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178
Practice Address - Country:US
Practice Address - Phone:702-660-2646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7320122300000X
CA102609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist