Provider Demographics
NPI:1518515618
Name:SHAW, DASHONIA (CNA)
Entity Type:Individual
Prefix:
First Name:DASHONIA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3053 N DELNO AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-4015
Mailing Address - Country:US
Mailing Address - Phone:559-274-2511
Mailing Address - Fax:
Practice Address - Street 1:3053 N DELNO AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-4015
Practice Address - Country:US
Practice Address - Phone:559-274-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-31
Last Update Date:2019-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6053576735320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities