Individual
KASIA LAYNE WALLACE-SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5270 BABCOCK ST NE STE 1, PALM BAY, FL 32905-4616
(321) 241-6800
(321) 241-6890
Mailing address
PO BOX 1137, MELBOURNE, FL 32902-1137
(321) 952-9696
(321) 952-7937
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME148403
FL
Other
Enumeration date
06/27/2018
Last updated
05/17/2024
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