Individual
SHAHNOUR YAYLAYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
24 JOLIET ST, DYER, IN 46311-1705
(219) 322-5747
(219) 864-2282
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01039144A
IN
2084P0804X
Child & Adolescent Psychiatry Physician
01039144A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200045990
—
IN
01
—
90000854
BCBSIL
IL
Enumeration date
09/16/2005
Last updated
10/09/2023
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