Individual
TIFFANY SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1618 INDIANA AVE, ALAMOGORDO, NM 88310-6670
(575) 430-5147
Mailing address
1618 INDIANA AVE, ALAMOGORDO, NM 88310-6670
(575) 430-5147
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
06/17/2015
Last updated
06/17/2015
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