Provider Demographics
NPI:1659326692
Name:SHAY, SAMUEL P (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:P
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 1:661 E ALTAMONTE DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5105
Mailing Address - Country:US
Mailing Address - Phone:407-831-4040
Mailing Address - Fax:407-260-0281
Practice Address - Street 1:661 E ALTAMONTE DR
Practice Address - Street 2:SUITE 115
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5105
Practice Address - Country:US
Practice Address - Phone:407-831-4040
Practice Address - Fax:407-260-0281
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26908OtherBCBS
FL26908YMedicare PIN
G01850Medicare UPIN