Provider Demographics
NPI:1598765349
Name:SHAIA, FRED T (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:T
Last Name:SHAIA
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 1:10200 THREE CHOPT RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-2012
Mailing Address - Country:US
Mailing Address - Phone:804-288-3277
Mailing Address - Fax:804-282-1043
Practice Address - Street 1:10200 THREE CHOPT RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-2012
Practice Address - Country:US
Practice Address - Phone:804-288-3277
Practice Address - Fax:804-282-1043
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA17492174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006547591Medicaid
VA006547591Medicaid
VAB05630Medicare UPIN