Individual
AMANDA JO SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
2180 MAIN ST, WAILUKU, HI 96793-1625
(808) 242-6464
Mailing address
2180 MAIN ST, WAILUKU, HI 96793-1625
(808) 242-6464
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
AMD-794
HI
363A00000X
Physician Assistant
—
TN
Other
Enumeration date
09/10/2012
Last updated
03/27/2018
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