Healthcare Provider Details

I. General information

NPI: 1275682445
Provider Name (Legal Business Name): DRS. SHAY AND ASSOCIATES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N NORTH ST
PEORIA IL
61606-1533
US

IV. Provider business mailing address

1201 N NORTH ST
PEORIA IL
61606-1533
US

V. Phone/Fax

Practice location:
  • Phone: 309-671-2310
  • Fax: 309-674-3560
Mailing address:
  • Phone: 309-671-2310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036048357
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036049845
License Number StateIL

VIII. Authorized Official

Name: SANIT SHAY
Title or Position: OWNER
Credential: MD
Phone: 309-671-2310