Provider Demographics
NPI:1871518076
Name:HAYES, SHAWN MICHAEL (MD)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:MICHAEL
Last Name:HAYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1901 THOMSON DRIVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1008
Mailing Address - Country:US
Mailing Address - Phone:434-947-5959
Mailing Address - Fax:434-384-1293
Practice Address - Street 1:1901 THOMSON DRIVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1008
Practice Address - Country:US
Practice Address - Phone:434-947-5959
Practice Address - Fax:434-384-1293
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057596207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005813271Medicaid
VAG70990Medicare UPIN
010685C04Medicare PIN
P00662847Medicare PIN