MEDICARE: CARMALITA YVETTE SHAW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1215575428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMALITA YVETTE SHAW

Provider Business Mailing Address
First Line	:	1310 WASHINGTON ST
Second Line	:
City	:	MARION
State	:	AL
Zip	:	36756-3218
Country	:	US
Telephone Number	:	334-628-2651
Fax Number	:	334-628-2656

Provider Business Practice Location Address
First Line	:	1310 WASHINGTON ST
Second Line	:
City	:	MARION
State	:	AL
Zip	:	36756-3218
Country	:	US
Telephone Number	:	334-683-2073
Fax Number	:	334-683-2077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2019
Last Update Date	:	12/18/2019

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Directions to “ CARMALITA YVETTE SHAW ” Practice Location

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