MEDICARE: DR. SHAISTA ASHAI 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	2084P0800X	Psychiatry Physician	0101230600	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	084520	OTHER	VA	SENTARA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	286711	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1659365989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAISTA ASHAI MD

Provider Business Mailing Address
First Line	:	856 J CLYDE MORRIS BLVD STE A
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-1318
Country	:	US
Telephone Number	:	757-316-5800
Fax Number	:	757-534-5190

Provider Business Practice Location Address
First Line	:	2244 EXECUTIVE DR
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-2430
Country	:	US
Telephone Number	:	757-827-1001
Fax Number	:	757-827-3128

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	09/27/2018

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