Provider Demographics
NPI:1780675546
Name:SHAW-DEVINE, ALLISON MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:MICHELLE
Last Name:SHAW-DEVINE
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:PO BOX 241578
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-0011
Mailing Address - Country:US
Mailing Address - Phone:501-603-1545
Mailing Address - Fax:501-686-6439
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-603-1545
Practice Address - Fax:501-686-6439
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1770207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135778001Medicaid
AR5AJ37OtherMEDICARE ARK
AR135778001Medicaid
G69674Medicare UPIN