Provider Demographics
NPI:1700520418
Name:SHAW, SHAVONE SHAMIL
Entity Type:Individual
Prefix:
First Name:SHAVONE
Middle Name:SHAMIL
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 1:4813 ROBBINS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1980
Mailing Address - Country:US
Mailing Address - Phone:321-315-3504
Mailing Address - Fax:
Practice Address - Street 1:4813 ROBBINS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-1980
Practice Address - Country:US
Practice Address - Phone:321-315-3504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide