Provider Demographics
NPI:1457133555
Name:SHAW, DOMINIQUE D
Entity Type:Individual
Prefix:MRS
First Name:DOMINIQUE
Middle Name:D
Last Name:SHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 18TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2806
Mailing Address - Country:US
Mailing Address - Phone:803-539-1919
Mailing Address - Fax:
Practice Address - Street 1:1018 18TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-2806
Practice Address - Country:US
Practice Address - Phone:803-539-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY7063998374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula