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General NPI Number Information
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NPI Number | 1720172422
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Entity Type | Individual
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Provider Name | JUDY KELLY SHAW MS, ANP-C
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 113 HOLLAND AVE, MC 111D VAMC
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City | ALBANY
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State | NY
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Zip | 12208
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Country | US
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Telephone | 518-626-6421
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Fax | 518-626-6564
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Provider Business Mailing Address
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Address Line | 167 WINDY HILL RD
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City | GREENWICH
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State | NY
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Zip | 12834
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Country | US
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Telephone | 518-695-4677
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Fax | 518-695-9621
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | F331353-1
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License Number State | NY
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