Individual
DOMINIQUE M SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
264 W 118TH ST, NEW YORK, NY 10026-1620
(212) 932-6500
Mailing address
7717B 247TH ST, BELLEROSE, NY 11426-1830
(310) 600-8263
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
282753
NY
207V00000X
Obstetrics & Gynecology Physician
A87149
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
282753
MEDICAL LICENSE NUMBER
NY
01
—
51655
MEDICAL LICENSE NUMBER
AZ
01
—
A87149
MEDICAL LICENSE NUMBER
CA
Enumeration date
05/15/2006
Last updated
02/22/2019
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