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General NPI Number Information
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NPI Number | 1952116501
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Entity Type | Individual
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Provider Name | RYAN PATRICK SHAW PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 1400 NW 12TH AVE STE 2
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City | MIAMI
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State | FL
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Zip | 33136-1003
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Country | US
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Telephone | 305-243-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 NW 14TH ST STE 1263Z
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City | MIAMI
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State | FL
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Zip | 33136-2107
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Country | US
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Telephone | 305-243-3000
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9119037
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License Number State | FL
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