Provider Demographics
NPI:1174350409
Name:SHAW, SHAUNA S
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:S
Last Name:SHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 CRUGER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8286
Mailing Address - Country:US
Mailing Address - Phone:845-857-5932
Mailing Address - Fax:
Practice Address - Street 1:3023 CRUGER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8286
Practice Address - Country:US
Practice Address - Phone:845-857-5932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator