Provider Demographics
NPI:1568462513
Name:SHAY, JEFFERY D (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:D
Last Name:SHAY
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:GUAM MEDICAL PLAZA, STE. 210
Mailing Address - Street 2:633 GOV. CARLOS CAMACHO RD
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-649-1001
Mailing Address - Fax:671-649-1002
Practice Address - Street 1:GUAM MEDICAL PLAZA, STE. 210
Practice Address - Street 2:633 GOV. CAMACHO RD
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-649-1001
Practice Address - Fax:671-649-1002
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME831452085R0204X
GUM-18852085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262972100Medicaid
FL03135YMedicare ID - Type Unspecified
H49804Medicare UPIN