Provider Demographics
NPI:1275856916
Name:SHAW, MAE MCALISTER (PA-C)
Entity Type:Individual
Prefix:
First Name:MAE
Middle Name:MCALISTER
Last Name:SHAW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MAE
Other - Middle Name:MCALISTER
Other - Last Name:PEASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:811 REDGATE AVE
Mailing Address - Street 2:POST OFFICE BOX 11049
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1515
Mailing Address - Country:US
Mailing Address - Phone:757-668-7007
Mailing Address - Fax:757-668-8656
Practice Address - Street 1:811 REDGATE AVE
Practice Address - Street 2:POST OFFICE BOX 11049
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1515
Practice Address - Country:US
Practice Address - Phone:757-668-7007
Practice Address - Fax:757-668-8658
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004339363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant