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General NPI Number Information
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NPI Number | 1447185772
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Entity Type | Individual
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Provider Name | DOUMINNEK SHAW
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Gender | Female
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Dates
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Enumeration Date | 06/17/2026
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Last Update Date | 06/17/2026
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Provider Practice Location Address
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Address Line | 2821 S 106TH ST APT 114
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City | WEST ALLIS
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State | WI
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Zip | 53227-3264
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Country | US
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Telephone | 262-676-7111
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Fax |
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Provider Business Mailing Address
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Address Line | 2821 S 106TH ST APT 114
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City | WEST ALLIS
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State | WI
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Zip | 53227-3264
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Country | US
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Telephone |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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