Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 004092 | KY |
Y | 225100000X | Physical Therapist | 2305205897 | VA |
NPI | 1003906793 |
---|---|
Provider Name | Gregory B Shasby |
First Address | Newport News, VA 23606-1990 |
Second Address | Glen Allen, VA 23060-6761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 19/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000331732 | ANTHEM BCBS PROVIDER ID (01) | KY |
1003906793 | (05) | VA |
342327 | BCBS (PHYSICAL THERAPY) (01) | VA |
7263602 | AETNA PROVIDER ID (01) | |
P00217523 | TRAVELERS MEDICARE ID (01) | KY |
P00930518 | RAILROAD MEDICARE (01) | VA |