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General NPI Number Information
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NPI Number | 1164206355
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Entity Type | Individual
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Provider Name | MS. TIARA SHAW
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Gender | Female
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 3542 BROOKSTONE DR APT C
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City | CINCINNATI
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State | OH
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Zip | 45209-1171
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Country | US
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Telephone | 513-570-0872
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Fax |
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Provider Business Mailing Address
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Address Line | 9420 TOWNE SQUARE AVE
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City | BLUE ASH
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State | OH
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Zip | 45242-6922
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Country | US
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Telephone | 513-399-2214
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | FSP000256
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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