Provider Demographics
NPI:1134406382
Name:SHAY, JUSTIN MICHAEL I (LMT)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:MICHAEL
Last Name:SHAY
Suffix:I
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 NASH LN # 6
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-3017
Mailing Address - Country:US
Mailing Address - Phone:203-212-0278
Mailing Address - Fax:
Practice Address - Street 1:2889 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-3211
Practice Address - Country:US
Practice Address - Phone:203-212-0278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006164174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist