MEDICARE: DASHONIA SHAW CNA

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	320700000X	Physical Disabilities Residential Treatment Facility	6053576735	CA

General Provider Information

NPI Number	:	1518515618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DASHONIA SHAW CNA

Provider Business Mailing Address
First Line	:	3053 N DELNO AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93705-4015
Country	:	US
Telephone Number	:	559-274-2511
Fax Number	:

Provider Business Practice Location Address
First Line	:	3053 N DELNO AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93705-4015
Country	:	US
Telephone Number	:	559-274-2511
Fax Number	:

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

Provider Enumeration Date	:	08/31/2019
Last Update Date	:	08/31/2019

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