Provider Demographics
NPI:1972682870
Name:SHAW, MANDY L (MD,)
Entity Type:Individual
Prefix:DR
First Name:MANDY
Middle Name:L
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD,
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Mailing Address - Street 1:1000 POLE CREEK XING
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-2901
Mailing Address - Country:US
Mailing Address - Phone:308-254-5544
Mailing Address - Fax:308-254-2672
Practice Address - Street 1:1000 POLE CREEK XING
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-2901
Practice Address - Country:US
Practice Address - Phone:308-254-5544
Practice Address - Fax:308-254-2672
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE22592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE30482OtherBCBS OF NEBRASKA
NEP00253777OtherRAILROAD MEDICARE
NE279052Medicare PIN
NE30482OtherBCBS OF NEBRASKA