Healthcare Provider Details

I. General information

NPI: 1215987144
Provider Name (Legal Business Name): RONALD SHASHY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/21/2014
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 Number39850
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: