Provider Demographics
NPI:1114050978
Name:SHAW, LORI PIGNATI (PA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:PIGNATI
Last Name:SHAW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:LORI
Other - Middle Name:RENEE
Other - Last Name:PIGNATI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1400 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-2612
Mailing Address - Country:US
Mailing Address - Phone:408-299-2160
Mailing Address - Fax:
Practice Address - Street 1:1400 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2612
Practice Address - Country:US
Practice Address - Phone:408-299-2160
Practice Address - Fax:650-299-2350
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16165363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant