Provider Demographics
NPI:1871578732
Name:STONE SHAYER, ANDREA L (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:STONE SHAYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 596
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-0596
Mailing Address - Country:US
Mailing Address - Phone:928-634-3025
Mailing Address - Fax:928-649-8800
Practice Address - Street 1:450 S WILLARD ST
Practice Address - Street 2:STE 115
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6743
Practice Address - Country:US
Practice Address - Phone:928-634-3025
Practice Address - Fax:928-649-8800
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15706207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ259053Medicaid
AZ22832Medicare ID - Type Unspecified
E82215Medicare UPIN