Provider Demographics
NPI:1356321764
Name:SHAW, LISA K (PMAC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:K
Last Name:SHAW
Suffix:
Gender:F
Credentials:PMAC
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:K
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NRCMA
Mailing Address - Street 1:PO BOX 526
Mailing Address - Street 2:23 N MAIN ST
Mailing Address - City:RIGLERVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17307
Mailing Address - Country:US
Mailing Address - Phone:717-677-9288
Mailing Address - Fax:717-677-4196
Practice Address - Street 1:6100 OLD JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112
Practice Address - Country:US
Practice Address - Phone:717-541-0988
Practice Address - Fax:717-541-8838
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3398OtherAPMAA