Provider Demographics
NPI:1538463328
Name:SHAW, AMY S (RN)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:S
Last Name:SHAW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 LINDA LN
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9217
Mailing Address - Country:US
Mailing Address - Phone:315-652-6193
Mailing Address - Fax:315-622-2670
Practice Address - Street 1:3422 LINDA LN
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9217
Practice Address - Country:US
Practice Address - Phone:315-652-6193
Practice Address - Fax:315-622-2670
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7252138163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse