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General NPI Number Information
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NPI Number | 1598910812
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Entity Type | Organization
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Legal Business Name | DANA SHAW MD PS
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 470 FRONT ST N
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City | ISSAQUAH
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State | WA
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Zip | 98027-2914
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Country | US
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Telephone | 425-392-0610
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Fax | 425-392-8979
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Provider Business Mailing Address
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Address Line | PO BOX 5202
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City | KENT
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State | WA
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Zip | 98064-5202
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Country | US
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Telephone | 253-520-0158
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Fax | 253-854-9860
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Authorized Official
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Title or Position | OWNER
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Name | DANA SHAW
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Credential | MD
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Telephone | 425-392-0610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD00031400
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License Number State | WA
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