Basic Information
| Provider Information | |||||||||
| NPI: | 1215165162 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAY | ||||||||
| FirstName: | ANDREW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 W CHARLESTON BLVD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026712273 | ||||||||
| FaxNumber: | 7023859399 | ||||||||
| Practice Location | |||||||||
| Address1: | 1707 W CHARLESTON BLVD | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026715150 | ||||||||
| FaxNumber: | 7023846493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2009 | ||||||||
| LastUpdateDate: | 06/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | 15405 | NV | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | RS20090316 | NM | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.