Provider Demographics
NPI:1598737991
Name:SHY, STEPHEN CRAIG II (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CRAIG
Last Name:SHY
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25708-0390
Mailing Address - Country:US
Mailing Address - Phone:304-429-1088
Mailing Address - Fax:304-429-3109
Practice Address - Street 1:601 20TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25703-1512
Practice Address - Country:US
Practice Address - Phone:304-781-0076
Practice Address - Fax:304-525-7402
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008017207P00000X
KY03066208D00000X
SC51270208D00000X
WV1947208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002199Medicaid
KY7100067340Medicaid
WV3810002199Medicaid