Provider Demographics
NPI:1578931416
Name:CAREY-SHAW, DONALD I (PT,LAC,WCC)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:CAREY-SHAW
Suffix:I
Gender:M
Credentials:PT,LAC,WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11719-9760
Mailing Address - Country:US
Mailing Address - Phone:516-578-8187
Mailing Address - Fax:
Practice Address - Street 1:1 ASTOR AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11719-9760
Practice Address - Country:US
Practice Address - Phone:516-578-8187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00002588-1171100000X
NY00005788-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist