1679666184 NPI number — MRS. MAUREEN A SHAW MS, ATC, LMT

Table of content: MRS. MAUREEN A SHAW MS, ATC, LMT (NPI 1679666184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679666184 NPI number — MRS. MAUREEN A SHAW MS, ATC, LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAW
Provider First Name:
MAUREEN
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, ATC, LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679666184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2697 BELLEWATER PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVIEDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-923-5495
Provider Business Mailing Address Fax Number:
928-223-0264

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3577 LAKE EMMA RD
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
LAKE MARY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32746-2056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-936-0314
Provider Business Practice Location Address Fax Number:
407-936-0316
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  AL1326 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: MA34636 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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