Provider Demographics
NPI:1548567597
Name:SHAW, SHELLY ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY ANN
Middle Name:
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 1:602 S 5TH AVE
Mailing Address - Street 2:PH
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4902
Mailing Address - Country:US
Mailing Address - Phone:914-619-6949
Mailing Address - Fax:
Practice Address - Street 1:602 S 5TH AVE
Practice Address - Street 2:PH
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-4902
Practice Address - Country:US
Practice Address - Phone:914-619-6949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-26
Last Update Date:2011-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY639136-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse