Provider Demographics
NPI:1821860131
Name:SHAW, BREANNA LYNN
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:LYNN
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 1:1324 MARYLAND AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-2260
Mailing Address - Country:US
Mailing Address - Phone:330-680-2130
Mailing Address - Fax:
Practice Address - Street 1:1324 MARYLAND AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-2260
Practice Address - Country:US
Practice Address - Phone:330-680-2130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health