Provider Demographics
NPI:1083234520
Name:SHAW, MIYAH ANTIONETTE
Entity Type:Individual
Prefix:
First Name:MIYAH
Middle Name:ANTIONETTE
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 1:1200 BROAD ST STE 104
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3573
Mailing Address - Country:US
Mailing Address - Phone:919-537-6565
Mailing Address - Fax:
Practice Address - Street 1:1200 BROAD ST STE 104
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3573
Practice Address - Country:US
Practice Address - Phone:919-537-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278H0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedHome Health