MEDICARE: MR. BERNARD DENNIS SHAW MED

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
1	235Z00000X	Speech-Language Pathologist	SL000187L	PA
2	235Z00000X	Speech-Language Pathologist	SP2191	OH
3	237600000X	Audiologist-Hearing Aid Fitter	AT000076L	PA
4	237600000X	Audiologist-Hearing Aid Fitter	F02191	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000114987	OTHER		ANTHEM BCBS

General Provider Information

NPI Number	:	1225148604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BERNARD DENNIS SHAW MED

Provider Business Mailing Address
First Line	:	1951 SHENANGO VALLEY FREEWAY
Second Line	:
City	:	HERMITAGE
State	:	PA
Zip	:	16148-2522
Country	:	US
Telephone Number	:	724-347-2005
Fax Number	:	724-347-4484

Provider Business Practice Location Address
First Line	:	1951 SHENANGO VALLEY FREEWAY
Second Line	:
City	:	HERMITAGE
State	:	PA
Zip	:	16148-2522
Country	:	US
Telephone Number	:	724-347-2005
Fax Number	:	724-347-4484

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	09/11/2025

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Directions to “ MR. BERNARD DENNIS SHAW MED” Practice Location

Language	Start Address	Practice Location

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