| Doctor Name: | DR. RENITA TA'SHA SHAW |
| NPI Number: | 1376783324 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPM |
| License Number: | 80199 |
| Business Practice Address: | 1434 Central Ave E Wiggins, MS - 395779602 |
| Business Phone Number: | 6019286700 |
| Business Fax Number: | 6019286731 |
| Mailing Address: | 1434 E Central Ave., Stone County Hospital WIGGINS |
| State: | MS |
| Postal Code: | 39503 |
| Phone Number: | 6019286700 |
| Fax Number: | 6019286731 |
| NPI Enumeration Date: | 03/04/2009 |
| NPI Last Update Date: | 06/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0131X |
| License Number: | 80199 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot Surgery |
| Taxonomy Definition: | |