Provider Demographics
NPI:1922052273
Name:SHAW, LINDA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1109
Mailing Address - Country:US
Mailing Address - Phone:330-543-8823
Mailing Address - Fax:330-296-6535
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-8823
Practice Address - Fax:330-296-6535
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN237913367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000247231OtherANTHEM PROVIDER
OH2358649Medicaid
OH2358649Medicaid