Provider Demographics
NPI:1710946033
Name:SHAW-NIEVES, CARMEL C (MD)
Entity Type:Individual
Prefix:
First Name:CARMEL
Middle Name:C
Last Name:SHAW-NIEVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MACKEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:MARTINS FERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43935
Mailing Address - Country:US
Mailing Address - Phone:740-635-7792
Mailing Address - Fax:740-635-7755
Practice Address - Street 1:500 MACKEY AVE
Practice Address - Street 2:
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1697
Practice Address - Country:US
Practice Address - Phone:740-635-7792
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350650302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0130405Medicaid
OHSH4072131Medicare ID - Type Unspecified
F51429Medicare UPIN