Provider Demographics
NPI:1346616158
Name:SHAW, DENISE CATHY
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:CATHY
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 1:11 PERKINS WAY
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-5749
Mailing Address - Country:US
Mailing Address - Phone:207-490-0740
Mailing Address - Fax:
Practice Address - Street 1:11 PERKINS WAY
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-5749
Practice Address - Country:US
Practice Address - Phone:207-490-0740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-16
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METO FOLLOW367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered