Provider Demographics
NPI:1356722284
Name:GATES, SHAYAN AMIR (DO)
Entity type:Individual
Prefix:DR
First Name:SHAYAN
Middle Name:AMIR
Last Name:GATES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 HEALTH CAMPUS DR FL 3
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8679
Mailing Address - Country:US
Mailing Address - Phone:540-689-5400
Mailing Address - Fax:757-579-8568
Practice Address - Street 1:2006 HEALTH CAMPUS DR FL 3
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:540-689-5400
Practice Address - Fax:757-579-8568
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS188292084N0400X
MT1256382084N0400X
OH34.0156962084N0400X
VA01022045222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology