Provider Demographics
NPI:1760108914
Name:SHAW, SHAMIYA (LMD)
Entity Type:Individual
Prefix:MS
First Name:SHAMIYA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:LMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 ZINSLE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45213-1856
Mailing Address - Country:US
Mailing Address - Phone:513-975-8753
Mailing Address - Fax:
Practice Address - Street 1:3909 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-1605
Practice Address - Country:US
Practice Address - Phone:513-975-8753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.024290225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist