Provider Demographics
NPI:1639687197
Name:SHAW, PHYLISS JOY (BSHE)
Entity Type:Individual
Prefix:
First Name:PHYLISS
Middle Name:JOY
Last Name:SHAW
Suffix:
Gender:F
Credentials:BSHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 CHAPEL HILL RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-1109
Mailing Address - Country:US
Mailing Address - Phone:919-323-7357
Mailing Address - Fax:
Practice Address - Street 1:2011 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-1109
Practice Address - Country:US
Practice Address - Phone:919-323-7357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker