Provider Demographics
NPI:1518559343
Name:SHAW, LEANNE (CNS)
Entity Type:Individual
Prefix:MS
First Name:LEANNE
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SHANNON WAY
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-3301
Mailing Address - Country:US
Mailing Address - Phone:610-906-7784
Mailing Address - Fax:
Practice Address - Street 1:300 BROOKSIDE AVE STE 75
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-3436
Practice Address - Country:US
Practice Address - Phone:484-209-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist