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General NPI Number Information
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NPI Number | 1497917165
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Entity Type | Individual
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Provider Name | TREVECCA KERRY SHAW DPM
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Gender | Male
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 09/29/2026
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Provider Practice Location Address
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Address Line | 2406 W BROADWAY
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City | LOUISVILLE
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State | KY
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Zip | 40211-1008
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Country | US
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Telephone | 502-775-1711
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Fax | 502-443-0369
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Provider Business Mailing Address
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Address Line | 1320 BELMONT AVE #1
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City | YOUNGSTOWN
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State | OH
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Zip | 44504-1130
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Country | US
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Telephone | 330-747-3910
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Fax | 330-747-3930
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 00338
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License Number State | KY
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