Individual
MICHAEL ED SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
130 FISHER RD UNIT 1, BERLIN, VT 05602-8132
(802) 371-4264
Mailing address
111 COLCHESTER AVE, BURLINGTON, VT 05401-1473
(802) 847-0000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
055.0031417
VT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/31/2018
Last updated
07/22/2025
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