Doctor Name: | DIANA SHAW |
NPI Number: | 1275523334 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | F330568-1 |
Business Practice Address: | 2888 Oneida St Sauquoit, NY - 134563110 |
Business Phone Number: | 3157320660 |
Business Fax Number: | 3157375220 |
Mailing Address: | 2888 Oneida St, SAUQUOIT |
State: | NY |
Postal Code: | 134563110 |
Phone Number: | 3157320660 |
Fax Number: | 3157375220 |
NPI Enumeration Date: | 10/28/2005 |
NPI Last Update Date: | 09/25/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | F330568-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |