Provider Demographics
NPI:1447235585
Name:SHAW-SCALA, CECILY HELEN (FNP C)
Entity Type:Individual
Prefix:MRS
First Name:CECILY
Middle Name:HELEN
Last Name:SHAW-SCALA
Suffix:
Gender:F
Credentials:FNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 E BARNETT RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8332
Mailing Address - Country:US
Mailing Address - Phone:541-789-8176
Mailing Address - Fax:541-789-4806
Practice Address - Street 1:555 BLACK OAK DR
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8447
Practice Address - Country:US
Practice Address - Phone:541-789-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418864363LF0000X
OR200250002NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP0077740OtherMEDICAL
Q56910Medicare UPIN
ZZZ03202ZMedicare ID - Type Unspecified