MEDICARE: JEFFERY D. SHAY MD

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	2085R0204X	Vascular & Interventional Radiology Physician	ME83145	FL
2	2085R0204X	Vascular & Interventional Radiology Physician	M-1885	GU

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568462513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY D. SHAY MD

Provider Business Mailing Address
First Line	:	GUAM MEDICAL PLAZA, STE. 210
Second Line	:	633 GOV. CARLOS CAMACHO RD
City	:	TAMUNING
State	:	GU
Zip	:	96913
Country	:	US
Telephone Number	:	671-649-1001
Fax Number	:	671-649-1002

Provider Business Practice Location Address
First Line	:	GUAM MEDICAL PLAZA, STE. 210
Second Line	:	633 GOV. CAMACHO RD
City	:	TAMUNING
State	:	GU
Zip	:	96913
Country	:	US
Telephone Number	:	671-649-1001
Fax Number	:	671-649-1002

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	10/17/2016

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Directions to “ JEFFERY D. SHAY MD” Practice Location

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