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General NPI Number Information
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NPI Number | 1396208260
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Entity Type | Individual
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Provider Name | STEPHANIE SHAW
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Gender | Female
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Dates
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Enumeration Date | 04/09/2019
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 7031 SW 62ND AVE FL 33143
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4701
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Country | US
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Telephone | 305-284-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 7830 PINE FORK DR
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City | ORLANDO
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State | FL
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Zip | 32822-7228
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Country | US
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Telephone | 407-516-5041
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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 |
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License Number State |
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