Individual
KAILIE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12901 BRUCE B DOWNS BLVD, TAMPA, FL 33612-4742
(813) 974-2388
Mailing address
PO BOX 917770, ORLANDO, FL 32891-7770
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME23867
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
049817300
—
FL
01
—
29783
BLUE CROSS BLUE SHIELD
DC
Enumeration date
08/18/2006
Last updated
06/16/2008
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