Provider Demographics
NPI:1932504594
Name:SHAW, ANNE (NMD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18789 N REEMS RD STE 260
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8648
Mailing Address - Country:US
Mailing Address - Phone:602-432-4055
Mailing Address - Fax:833-264-1970
Practice Address - Street 1:18789 N REEMS RD STE 260
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8648
Practice Address - Country:US
Practice Address - Phone:602-432-4055
Practice Address - Fax:833-264-1970
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14-1455207Q00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine