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Individual

JANA SHAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
238 ARSENAL ST, WATERTOWN, NY 13601-2504
(315) 782-6400
(315) 782-1330
Mailing address
20830 CAGWIN RD, WATERTOWN, NY 13601-5364
(315) 782-6400
(315) 782-1330

Taxonomy

Speciality
Code
Description
License number
State
2080P0208X
Pediatric Infectious Diseases Physician
Primary
239174
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02462559
NY
01
239174
LICENSE NUMBER
NY
Enumeration date
06/02/2006
Last updated
10/20/2010
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