Provider Demographics
NPI:1053100453
Name:SHAW, PAMELA
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:SHAW
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10365 ULMERTON RD LOT 77
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4131
Mailing Address - Country:US
Mailing Address - Phone:727-688-8613
Mailing Address - Fax:727-688-8613
Practice Address - Street 1:801 W BAY DR STE 504
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-3278
Practice Address - Country:US
Practice Address - Phone:727-433-8227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA93543225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist