Individual
LESLIE A SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LD, PA-C
Contact information
Practice address
32800 LORAIN RD STE 2300, NORTH RIDGEVILLE, OH 44039-3430
(440) 406-5500
Mailing address
850 COLUMBIA RD STE 200, WESTLAKE, OH 44145-7215
(440) 808-1212
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
6251
OH
363A00000X
Physician Assistant
Primary
50.005005RX
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0217187
—
OH
Enumeration date
09/30/2008
Last updated
01/12/2021
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