Healthcare Provider Details

I. General information

NPI: 1437088994
Provider Name (Legal Business Name): JESSICA LEE SHAW DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 6TH ST SW
CANTON OH
44710-1702
US

IV. Provider business mailing address

2600 6TH ST SW
CANTON OH
44710-1702
US

V. Phone/Fax

Practice location:
  • Phone: 330-596-6000
  • Fax: 330-596-7752
Mailing address:
  • Phone: 330-596-6000
  • Fax: 330-596-7752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number59.001117
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: