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General NPI Number Information
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NPI Number | 1295516367
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Entity Type | Individual
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Provider Name | JEFFREY SHAY
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Gender | Male
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Dates
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Enumeration Date | 10/13/2023
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 10560 SW STEPHANIE WAY APT 202
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34987-2328
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Country | US
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Telephone | 772-238-0702
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Fax | 772-237-5823
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Provider Business Mailing Address
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Address Line | 1902 SW GRANELLO TER
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-1136
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Country | US
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Telephone | 772-238-0702
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Fax | 772-237-5823
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State | FL
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