Provider Demographics
NPI:1215987144
Name:SHASHY, RONALD (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:SHASHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 LEXINGTON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9330
Mailing Address - Country:US
Mailing Address - Phone:502-867-7806
Mailing Address - Fax:502-867-7836
Practice Address - Street 1:1140 LEXINGTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9330
Practice Address - Country:US
Practice Address - Phone:502-867-7806
Practice Address - Fax:502-867-7836
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39850207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64114002Medicaid
KY39850OtherLICENSE
TNMD0000042641OtherTN MEDICAL LICENSE
KY0990501Medicare ID - Type Unspecified
KY64114002Medicaid