Provider Demographics
NPI:1093726663
Name:SHAW, SYLVIA J (MD)
Entity Type:Individual
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First Name:SYLVIA
Middle Name:J
Last Name:SHAW
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3633 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:#2
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262
Mailing Address - Country:US
Mailing Address - Phone:310-537-6397
Mailing Address - Fax:310-537-7550
Practice Address - Street 1:3621 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:#6
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-3512
Practice Address - Country:US
Practice Address - Phone:310-537-6397
Practice Address - Fax:310-537-7558
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2012-09-25
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Provider Licenses
StateLicense IDTaxonomies
CAG50246207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G502461Medicaid
CA00G502461Medicaid
E79778Medicare UPIN