Healthcare Provider Details

I. General information

NPI: 1346105673
Provider Name (Legal Business Name): WILLIAM L SHAW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MADISON AVE STE 340
TOLEDO OH
43604-1277
US

IV. Provider business mailing address

35 S SAINT CLAIR ST APT 205
DAYTON OH
45402-2149
US

V. Phone/Fax

Practice location:
  • Phone: 419-356-1465
  • Fax:
Mailing address:
  • Phone: 937-478-1658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: