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General NPI Number Information
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NPI Number | 1578144515
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Entity Type | Individual
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Provider Name | AVI SHAW
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Gender | Male
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Dates
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Enumeration Date | 04/20/2021
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Last Update Date | 06/28/2021
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Provider Practice Location Address
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Address Line | 8401 MARKET ST
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City | BOARDMAN
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State | OH
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Zip | 44512-6725
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Country | US
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Telephone | 443-805-7713
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Fax |
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Provider Business Mailing Address
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Address Line | 7707 E 6TH ST
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-5715
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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 | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 58.032292
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License Number State | OH
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