Provider Demographics
NPI:1255375994
Name:SHAY, JOHN A (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
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 1:13450 N MERIDIAN ST
Mailing Address - Street 2:SUITE 244
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1546
Mailing Address - Country:US
Mailing Address - Phone:317-846-4484
Mailing Address - Fax:317-571-2344
Practice Address - Street 1:13450 N MERIDIAN ST
Practice Address - Street 2:SUITE 244
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1546
Practice Address - Country:US
Practice Address - Phone:317-846-4484
Practice Address - Fax:317-571-2344
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10139661174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN314010Medicare ID - Type Unspecified
INE45941Medicare UPIN