Provider Demographics
NPI:1033729959
Name:SHAW, JULIET N/A
Entity Type:Individual
Prefix:MS
First Name:JULIET
Middle Name:N/A
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 1:9221 NW 14TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4545
Mailing Address - Country:US
Mailing Address - Phone:954-471-7278
Mailing Address - Fax:
Practice Address - Street 1:16800 NW 2ND AVE # 400
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-5501
Practice Address - Country:US
Practice Address - Phone:305-654-3718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11009003363LG0600X
FLRN9379405163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WH1000XNursing Service ProvidersRegistered NurseHospice