Provider Demographics
NPI:1750027272
Name:SHAW, ALESHIA KEWANNA
Entity Type:Individual
Prefix:
First Name:ALESHIA
Middle Name:KEWANNA
Last Name:SHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 HUDSON LN STE 202
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-6032
Mailing Address - Country:US
Mailing Address - Phone:318-323-1300
Mailing Address - Fax:318-323-1400
Practice Address - Street 1:1424 ELLIS LN
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-5511
Practice Address - Country:US
Practice Address - Phone:318-535-2674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-08
Last Update Date:2022-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator