Provider Demographics
NPI:1942358965
Name:DEAN, SHAY BYRON (MD)
Entity Type:Individual
Prefix:
First Name:SHAY
Middle Name:BYRON
Last Name:DEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2200 NORTH MAYFAIR ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2252
Mailing Address - Country:US
Mailing Address - Phone:414-258-9511
Mailing Address - Fax:414-607-3948
Practice Address - Street 1:4832 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292
Practice Address - Country:US
Practice Address - Phone:310-482-6910
Practice Address - Fax:310-496-0252
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2009-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA960102086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery