Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 0101033094 | VA |
NPI | 1245362730 |
---|---|
Provider Name | Robert Steven Shayne |
First Address | Chester, VA 23831-4261 |
Second Address | Chester, VA 23831-4261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6796192 | (05) | VA |
F75832 | (02) | VA |