Provider Demographics
NPI:1316953631
Name:HAYAT, SHAUKAT (MD)
Entity type:Individual
Prefix:DR
First Name:SHAUKAT
Middle Name:
Last Name:HAYAT
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 1:145 HOSPITAL AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1462
Mailing Address - Country:US
Mailing Address - Phone:814-375-3915
Mailing Address - Fax:814-375-3712
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1462
Practice Address - Country:US
Practice Address - Phone:814-375-3915
Practice Address - Fax:814-375-3712
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-036504-L207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011907350001Medicaid
PA1011907350001Medicaid
PA012352Medicare ID - Type Unspecified