Individual
CODY EUGENE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
NUMI, TROUT AVE BUILDING 83, GROTON, CT 06340
(860) 694-2876
Mailing address
5 WELLS ST, GROTON, CT 06340-3336
(682) 553-2447
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
03/26/2019
Last updated
03/26/2019
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