Provider Demographics
NPI:1255736039
Name:SHAW, BRANDON MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MICHAEL
Last Name:SHAW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2799 W. GRAND BLVD.
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202
Mailing Address - Country:US
Mailing Address - Phone:313-870-1734
Mailing Address - Fax:313-870-1701
Practice Address - Street 1:2799 W. GRAND BLVD.
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:313-870-1734
Practice Address - Fax:313-870-1701
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZG1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGeneticist, Medical (PhD)