Provider Demographics
NPI:1407574817
Name:SHAW, ORIANNA
Entity Type:Individual
Prefix:
First Name:ORIANNA
Middle Name:
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 1:25 COUNTY ROAD 345
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MS
Mailing Address - Zip Code:38673-4550
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 COUNTY ROAD 345
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MS
Practice Address - Zip Code:38673-4550
Practice Address - Country:US
Practice Address - Phone:662-715-0616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program