Provider Demographics
NPI:1225007644
Name:STOKES, SHAYNE C (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAYNE
Middle Name:C
Last Name:STOKES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 LOCUST ST N STE 600
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4164
Mailing Address - Country:US
Mailing Address - Phone:208-734-6091
Mailing Address - Fax:
Practice Address - Street 1:1502 LOCUST ST N STE 600
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4164
Practice Address - Country:US
Practice Address - Phone:208-734-6091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV21289207K00000X
VA0101234499207K00000X, 208000000X
IDM-15682207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics