Provider Demographics
NPI:1003861303
Name:SHAYA, ELIAS K (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:K
Last Name:SHAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:905 FALLSCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-1705
Mailing Address - Country:US
Mailing Address - Phone:410-561-3303
Mailing Address - Fax:
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:RMB 406
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2905
Practice Address - Country:US
Practice Address - Phone:410-532-4540
Practice Address - Fax:410-323-6958
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00389572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD069761300Medicaid
MDE32836Medicare UPIN
MD069761300Medicaid