Provider Demographics
NPI:1508424854
Name:SHAWVER, JAMIE CHRISTINE (DO)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:CHRISTINE
Last Name:SHAWVER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SOUTH RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2483
Mailing Address - Country:US
Mailing Address - Phone:860-284-9544
Mailing Address - Fax:860-284-9548
Practice Address - Street 1:11 SOUTH RD STE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2483
Practice Address - Country:US
Practice Address - Phone:860-284-9544
Practice Address - Fax:860-284-9548
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-02
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1.076096207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ39902478138177Medicaid