Provider Demographics
NPI:1710506183
Name:SHADE, HAYLEY M (MD)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:M
Last Name:SHADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 8TH ST. W.
Mailing Address - Street 2:4TH FLOOR, LRC 653-1 WEST 8TH STREET, L18
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:655 8TH ST. W.
Practice Address - Street 2:4TH FLOOR, LRC 653-1 WEST 8TH STREET, L18
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209
Practice Address - Country:US
Practice Address - Phone:904-244-3907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program