Provider Demographics
NPI:1407410913
Name:SHAW, ANDREW JOHN
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JOHN
Last Name:SHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 HOLLYBURNE AVE
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-1309
Mailing Address - Country:US
Mailing Address - Phone:760-703-0996
Mailing Address - Fax:
Practice Address - Street 1:1375 HOLLYBURNE AVE
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-1309
Practice Address - Country:US
Practice Address - Phone:760-703-0996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS