Provider Demographics
NPI:1275867863
Name:SHAW, STACY LYNN (CD (DONA))
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:LYNN
Last Name:SHAW
Suffix:
Gender:F
Credentials:CD (DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5732 CLOVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ELIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-1370
Mailing Address - Country:US
Mailing Address - Phone:419-339-9600
Mailing Address - Fax:
Practice Address - Street 1:5732 CLOVER RIDGE DR
Practice Address - Street 2:
Practice Address - City:ELIDA
Practice Address - State:OH
Practice Address - Zip Code:45807-1370
Practice Address - Country:US
Practice Address - Phone:419-339-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula