Provider Demographics
NPI:1609517010
Name:SHAW, CRYSTAL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 LEROI DR
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5931
Mailing Address - Country:US
Mailing Address - Phone:336-909-1334
Mailing Address - Fax:
Practice Address - Street 1:777 NORTH ST STE 203
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4123
Practice Address - Country:US
Practice Address - Phone:413-499-8590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2339749363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner