Provider Demographics
NPI:1366499220
Name:MAYYA, SHAY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAY
Middle Name:
Last Name:MAYYA
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 1:5930 ROYAL LN STE E119
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3849
Mailing Address - Country:US
Mailing Address - Phone:469-215-5363
Mailing Address - Fax:
Practice Address - Street 1:5930 ROYAL LN STE E119
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-3849
Practice Address - Country:US
Practice Address - Phone:469-215-5363
Practice Address - Fax:844-804-0653
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301081763207R00000X
TXN9264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283690001Medicaid
TX283690002Medicaid
TX8CX455OtherBCBS
TX8CX455OtherBCBS
TXTXB134067Medicare PIN