Healthcare Provider Details

I. General information

NPI: 1154331387
Provider Name (Legal Business Name): EAR NOSE AND THROAT SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 LEXINGTON RD SUITE 102
GEORGETOWN KY
40324-9330
US

IV. Provider business mailing address

1140 LEXINGTON RD SUITE 102
GEORGETOWN KY
40324-9330
US

V. Phone/Fax

Practice location:
  • Phone: 502-867-7806
  • Fax: 502-867-7836
Mailing address:
  • Phone: 502-867-7806
  • Fax: 502-867-7836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RONALD G SHASHY
Title or Position: OWNER
Credential: MD
Phone: 502-867-7806