Individual
DR. TREVECCA KERRY SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2406 W BROADWAY, LOUISVILLE, KY 40211-1008
(502) 775-1711
(502) 443-0369
Mailing address
1320 BELMONT AVE, #1, YOUNGSTOWN, OH 44504-1130
(330) 747-3910
(330) 747-3930
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
00338
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000614278
ANTHEM
—
05
—
2919864
—
OH
Enumeration date
06/25/2008
Last updated
03/17/2021
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