Individual
JESSALYN SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(774) 442-6629
(774) 443-7399
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
036.148617
IL
208000000X
Pediatrics Physician
1021425
MA
208000000X
Pediatrics Physician
125.068279
IL
2080C0008X
Child Abuse Pediatrics Physician
Primary
1021425
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2016
Last updated
10/09/2024
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