Provider Demographics
NPI:1720172422
Name:SHAW, JUDY KELLY (MS, ANP-C)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:KELLY
Last Name:SHAW
Suffix:
Gender:F
Credentials:MS, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 WINDY HILL RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:NY
Mailing Address - Zip Code:12834
Mailing Address - Country:US
Mailing Address - Phone:518-695-4677
Mailing Address - Fax:518-695-9621
Practice Address - Street 1:113 HOLLAND AVE, MC 111D
Practice Address - Street 2:VAMC
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-626-6421
Practice Address - Fax:518-626-6564
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331353-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health