=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255375994
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN A SHAY M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13450 N MERIDIAN ST SUITE 244
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46032-1546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-846-4484
-----------------------------------------------------
Fax | 317-571-2344
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13450 N MERIDIAN ST SUITE 244
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46032-1546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-846-4484
-----------------------------------------------------
Fax | 317-571-2344
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 10139661
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------