Provider Demographics
NPI:1225289002
Name:SHAW, DAYCO LASHELL
Entity Type:Individual
Prefix:
First Name:DAYCO
Middle Name:LASHELL
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:PO BOX 36252
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-1252
Mailing Address - Country:US
Mailing Address - Phone:910-568-5017
Mailing Address - Fax:910-568-5017
Practice Address - Street 1:1187 WRENWOOD CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5810
Practice Address - Country:US
Practice Address - Phone:910-568-5017
Practice Address - Fax:910-568-5017
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker