Individual
AMANDA SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PRSS
Contact information
Practice address
405 CAPITOL ST STE 907, CHARLESTON, WV 25301-1786
(304) 444-6090
Mailing address
405 CAPITOL ST STE 907, CHARLESTON, WV 25301-1786
(304) 444-6090
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
23-9153
WV
Other
Enumeration date
07/19/2023
Last updated
04/30/2024
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