Individual
SHANAE VIZZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9480 DOUBLE DIAMOND PKWY STE 200, RENO, NV 89521-5842
(775) 348-8800
(833) 687-1419
Mailing address
5310 KIETZKE LN STE 104, RENO, NV 89511-2043
(775) 348-8800
(833) 687-1419
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA.0006863
CO
363A00000X
Physician Assistant
Primary
PA2563
NV
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
PA2563
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457920076
—
NV
01
—
V71859
MEDICARE NV
NV
Enumeration date
06/18/2021
Last updated
04/22/2026
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