Individual
CAROL SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
926 WHEELER AVE, BRONX, NY 10473-4513
(917) 214-7624
Mailing address
926 WHEELER AVE, BRONX, NY 10473-4513
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
474563
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
474563
—
NY
Enumeration date
04/03/2019
Last updated
04/03/2019
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