Provider Demographics
NPI:1851518955
Name:SHAW, JEFFREY HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HENRY
Last Name:SHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 CHAPMAN LN UNIT 25
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-6714
Mailing Address - Country:US
Mailing Address - Phone:216-272-0775
Mailing Address - Fax:
Practice Address - Street 1:1150 CHAPMAN LN UNIT 25
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-6714
Practice Address - Country:US
Practice Address - Phone:216-272-0775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57-010589208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics