Provider Demographics
NPI:1003921636
Name:SHAW, STANLEY YANG (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:YANG
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:375 BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-6007
Mailing Address - Country:US
Mailing Address - Phone:857-307-0896
Mailing Address - Fax:857-307-0899
Practice Address - Street 1:55 FRUIT STREET
Practice Address - Street 2:YAW 5 CARDIAC UNIT ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-6750
Practice Address - Fax:617-724-6767
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204785207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3208354Medicaid
MAJ22338OtherBCBS
MA204785OtherTUFTS HEALTH PLAN
H14743Medicare UPIN
MAA30950Medicare ID - Type Unspecified