Individual
STACY SHANE SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
725 NORTH ST, PITTSFIELD, MA 01201-4109
(413) 447-2000
Mailing address
3814 SE 98TH AVE, PORTLAND, OR 97266-2502
(503) 313-9634
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
11/10/2020
Last updated
11/10/2020
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