Individual
BERNICE SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1916 CHERRY GLEN DR, 1916 CHERRY GLEN DRIVE, LA GRANGE, KY 40031-6967
(954) 940-8205
Mailing address
1916 CHERRY GLEN DR, LA GRANGE, KY 40031-6967
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
11/28/2025
Last updated
11/28/2025
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