Provider Demographics
NPI:1679666184
Name:SHAW, MAUREEN A (MS, ATC, LMT)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:A
Last Name:SHAW
Suffix:
Gender:F
Credentials:MS, ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2697 BELLEWATER PLACE
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765
Mailing Address - Country:US
Mailing Address - Phone:407-923-5495
Mailing Address - Fax:928-223-0264
Practice Address - Street 1:3577 LAKE EMMA RD
Practice Address - Street 2:SUITE 109
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2056
Practice Address - Country:US
Practice Address - Phone:407-936-0314
Practice Address - Fax:407-936-0316
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL13262255A2300X
FLMA34636225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer