MEDICARE: DANA JILL SHAY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	3704	FL

General Provider Information

NPI Number	:	1194072488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA JILL SHAY LCSW

Provider Business Mailing Address
First Line	:	6117 NW 124TH DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-1916
Country	:	US
Telephone Number	:	954-340-5474
Fax Number	:

Provider Business Practice Location Address
First Line	:	6117 NW 124TH DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33076-1916
Country	:	US
Telephone Number	:	954-340-5474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	08/06/2012

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Directions to “ DANA JILL SHAY LCSW” Practice Location

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