Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 69318 | WI |
NPI | 1235497181 |
---|---|
Provider Name | Dr. Sophie Grace Shay |
First Address | Milwaukee, WI 53226-4874 |
Second Address | Milwaukee, WI 53226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2012 |
Last Update Date | 10/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1235497181 | (05) | WI |