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NPI Code Detail

MEDICARE: SHUNTOYIA YSHAY SHAW PBT

MEDICARE:   SHUNTOYIA YSHAY SHAW  PBT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1246RP1900XPhlebotomy Technician42787TX

General Provider Information

NPI Number : 1043839582
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHUNTOYIA YSHAY SHAW PBT
Provider Business Mailing Address
First Line : 9149 BARBARO DR APT 7108
Second Line :
City : FORT WORTH
State : TX
Zip : 76140-1889
Country : US
Telephone Number : 682-760-1879
Fax Number :
Provider Business Practice Location Address
First Line : 9149 BARBARO DR APT 7108
Second Line :
City : FORT WORTH
State : TX
Zip : 76140-1889
Country : US
Telephone Number : 682-760-1879
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2020
Last Update Date : 04/14/2020

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Directions to “ SHUNTOYIA YSHAY SHAW PBT” Practice Location

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