Provider Demographics
NPI:1437175346
Name:SHAY, MONA DIANE (DO)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:DIANE
Last Name:SHAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3722 DRESSLER RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2700
Mailing Address - Country:US
Mailing Address - Phone:330-479-9000
Mailing Address - Fax:330-477-5805
Practice Address - Street 1:3722 DRESSLER RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2700
Practice Address - Country:US
Practice Address - Phone:330-479-9000
Practice Address - Fax:330-477-5805
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34 005560207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0950896Medicaid
F48978Medicare UPIN
0732292Medicare ID - Type Unspecified