Provider Demographics
NPI:1356685135
Name:SHAW, HEATHER RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:SHAW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WALDEN RIDGE DR STE 10
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8592
Mailing Address - Country:US
Mailing Address - Phone:833-365-7246
Mailing Address - Fax:
Practice Address - Street 1:9 WALDEN RIDGE DR STE 10
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8592
Practice Address - Country:US
Practice Address - Phone:833-365-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106340363A00000X
363A00000X
NC0010-06889363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant