Individual
CATHERINE SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
107 WIRT AVE, STATEN ISLAND, NY 10309-4257
(718) 554-4813
Mailing address
107 WIRT AVE, STATEN ISLAND, NY 10309-4257
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
854007141
NY
Other
Enumeration date
07/28/2014
Last updated
07/28/2014
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