Provider Demographics
NPI:1063451870
Name:SHY, KATHY E (MD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:E
Last Name:SHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6179
Mailing Address - Street 2:4449 STATE ROUTE 159
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-6179
Mailing Address - Country:US
Mailing Address - Phone:740-772-7892
Mailing Address - Fax:740-773-1264
Practice Address - Street 1:4449 STATE ROUTE 159
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-6179
Practice Address - Country:US
Practice Address - Phone:740-772-7892
Practice Address - Fax:740-773-1264
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350520062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000254658OtherANTHEM
OH246799000OtherMAGELLAN
OH0610806Medicaid
OH0610806Medicaid
OHSH4025792Medicare UPIN
OH246799000OtherMAGELLAN