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General NPI Number Information
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NPI Number | 1851518955
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Entity Type | Individual
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Provider Name | JEFFREY HENRY SHAW M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1150 CHAPMAN LN UNIT 25
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City | MEDINA
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State | OH
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Zip | 44256-6714
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Country | US
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Telephone | 216-272-0775
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 CHAPMAN LN UNIT 25
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City | MEDINA
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State | OH
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Zip | 44256-6714
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Country | US
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Telephone | 216-272-0775
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 57-010589
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License Number State | OH
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