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General NPI Number Information
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NPI Number | 1558840470
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Entity Type | Individual
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Provider Name | KIRSTEN ELISE SHAW MD
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Gender | Female
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 1510 E MAIN ST STE 104C
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City | SANTA MARIA
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State | CA
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Zip | 93454-4825
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Country | US
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Telephone | 805-928-5767
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Fax | 805-349-0222
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Provider Business Mailing Address
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Address Line | 1510 E MAIN ST STE 104C
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City | SANTA MARIA
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State | CA
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Zip | 93454-4825
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Country | US
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Telephone | 805-928-5767
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Fax | 805-349-0222
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 66783
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A202815
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License Number State | CA
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