Healthcare Provider Details

I. General information

NPI: 1801729074
Provider Name (Legal Business Name): MYA SHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 N MAIN ST
CAPE MAY COURT HOUSE NJ
08210-2122
US

IV. Provider business mailing address

127 TYLER RD
CORBIN CITY NJ
08270-9627
US

V. Phone/Fax

Practice location:
  • Phone: 609-486-2003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL07464700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: