Provider Demographics
NPI:1124360359
Name:SHAW, AMY LEAH (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LEAH
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:525 E 68TH ST., BOX 39
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065
Mailing Address - Country:US
Mailing Address - Phone:212-746-1677
Mailing Address - Fax:
Practice Address - Street 1:525 E. 68TH ST.
Practice Address - Street 2:PAYSON 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:212-746-7000
Practice Address - Fax:646-697-0029
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY283111207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine