Individual
JAQUAN SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
426 OLD OAK DR APT 201, NEWPORT NEWS, VA 23602-4267
(757) 381-4456
Mailing address
426 OLD OAK DR APT 201, NEWPORT NEWS, VA 23602-4267
(757) 381-4456
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
05/04/2022
Last updated
05/04/2022
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