Provider Demographics
NPI:1972633147
Name:SHAW, NANCY M (PA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:SHAW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SANBORN RD
Mailing Address - Street 2:
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3816
Mailing Address - Country:US
Mailing Address - Phone:925-254-0446
Mailing Address - Fax:510-521-7947
Practice Address - Street 1:2433 CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4564
Practice Address - Country:US
Practice Address - Phone:510-521-2300
Practice Address - Fax:510-521-7947
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA12949363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical