Provider Demographics
NPI:1902822893
Name:SHAW, ROBIN L (ANP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:L
Last Name:SHAW
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 NICHOLS STREET
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559
Mailing Address - Country:US
Mailing Address - Phone:585-637-7558
Mailing Address - Fax:585-637-7566
Practice Address - Street 1:42 NICHOLS STREET
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559
Practice Address - Country:US
Practice Address - Phone:585-637-7558
Practice Address - Fax:585-637-7566
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF300952363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000560051002OtherCOMMUNITY BLUE
00010009201OtherUNIVERA
NY005605512OtherBCBS WESTERN NY
NYP010000065OtherBCBS ROCHESTER
109177BJOtherPREFERRED CARE
9511861OtherINDEPENDENT HEALTH
NY005605512OtherBCBS WESTERN NY
109177BJOtherPREFERRED CARE