Provider Demographics
NPI:1578564217
Name:COOPER, SHEILA (MD)
Entity type:Individual
Prefix:DR
First Name:SHEILA
Middle Name:
Last Name:COOPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:DARLENE
Other - Last Name:GAUGHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3157 N RAINBOW BLVD
Mailing Address - Street 2:#518
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4578
Mailing Address - Country:US
Mailing Address - Phone:702-386-4700
Mailing Address - Fax:702-386-4701
Practice Address - Street 1:2850 S MOJAVE RD LOT A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-1355
Practice Address - Country:US
Practice Address - Phone:702-386-4700
Practice Address - Fax:702-386-4701
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68831207L00000X
NV8311207L00000X
IL036162159207L00000X
HI11875207L00000X
WI102085-875207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000236455OtherHMSA PROVIDER NUMBER
NVBG302OtherMEDICARE PTAN
HIP00070482OtherRAILROAD MEDICARE
HIMD11875OtherSTATE LICENCE
HIMD11875OtherSTATE LICENCE
HIF28902Medicare UPIN