Provider Demographics
NPI:1568446482
Name:SHAYA, MARK R (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:R
Last Name:SHAYA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:201 BIRD RD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1402
Mailing Address - Country:US
Mailing Address - Phone:305-325-4873
Mailing Address - Fax:305-325-4883
Practice Address - Street 1:201 BIRD RD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1402
Practice Address - Country:US
Practice Address - Phone:305-325-4873
Practice Address - Fax:305-325-4883
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME92901207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16919Medicare PIN
FLI52517Medicare UPIN