Provider Demographics
NPI:1558936641
Name:SHAW, WILLIAM DEAN
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DEAN
Last Name:SHAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 DOUGLASS RD SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-6582
Mailing Address - Country:US
Mailing Address - Phone:202-271-7797
Mailing Address - Fax:
Practice Address - Street 1:2611 DOUGLASS RD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6582
Practice Address - Country:US
Practice Address - Phone:202-271-7797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver