Provider Demographics
NPI:1609239417
Name:SHAW, TACI (MALDT)
Entity Type:Individual
Prefix:MRS
First Name:TACI
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:MALDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2426 VINEYARD LN
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1114
Mailing Address - Country:US
Mailing Address - Phone:443-448-8689
Mailing Address - Fax:
Practice Address - Street 1:2145 PRIEST BRIDGE DR
Practice Address - Street 2:SUITE #4
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2477
Practice Address - Country:US
Practice Address - Phone:443-449-8689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist