Individual
WARREN THOMAS SHAW III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
953 DANBY RD, ITHACA, NY 14850-7002
(607) 274-3011
Mailing address
2 LONGVIEW DR, CLIFTON PARK, NY 12065-2326
(518) 915-0497
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/05/2019
Last updated
03/05/2019
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