Provider Demographics
NPI:1912467721
Name:SHAW, CATHERINE L (RDN)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:L
Last Name:SHAW
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 NEW ENGLAND CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-7464
Mailing Address - Country:US
Mailing Address - Phone:304-363-3362
Mailing Address - Fax:
Practice Address - Street 1:274 NEW ENGLAND CIR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-7464
Practice Address - Country:US
Practice Address - Phone:304-363-3362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV171133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered