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General NPI Number Information
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NPI Number | 1154117000
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Entity Type | Individual
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Provider Name | SARA SHAW CT
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Gender | Female
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Dates
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Enumeration Date | 04/17/2025
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 217 W. 3RD ST.
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City | PERRYSBURG
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State | OH
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Zip | 43551
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Country | US
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Telephone | 419-806-6663
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Fax |
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Provider Business Mailing Address
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Address Line | 524 BUTTERNUT LN
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City | TOLEDO
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State | OH
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Zip | 43615-6661
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Country | US
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Telephone | 419-351-0072
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | C.2506600-TRNE
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License Number State | OH
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