Individual
LAQUANTA S SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NON TYPICAL
Contact information
Practice address
4160 TAHOE CT, INDIANAPOLIS, IN 46235-8823
(317) 627-8590
Mailing address
55 S STATE AVE STE 353, INDIANAPOLIS, IN 46201-3890
(317) 627-8590
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
2350-45-6933
IN
374U00000X
Home Health Aide
HHA0901819
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152957
—
IN
Enumeration date
08/14/2019
Last updated
09/16/2025
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