Provider Demographics
NPI:1619931797
Name:SHAYA, ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:SHAYA
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 1:600 HERITAGE DR
Mailing Address - Street 2:STE 210
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3000
Mailing Address - Country:US
Mailing Address - Phone:561-354-1515
Mailing Address - Fax:
Practice Address - Street 1:600 HERITAGE DR
Practice Address - Street 2:210
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3000
Practice Address - Country:US
Practice Address - Phone:561-354-1515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89421207V00000X
LA024409207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H48420Medicare UPIN