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NPI Code Detail

MEDICARE: DR. TREVECCA KERRY SHAW DPM

MEDICARE: DR. TREVECCA KERRY SHAW DPM
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
1213ES0103XFoot & Ankle Surgery Podiatrist00338KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000614278OTHERANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497917165
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TREVECCA KERRY SHAW DPM
Provider Business Mailing Address
First Line : 1320 BELMONT AVE
Second Line : #1
City : YOUNGSTOWN
State : OH
Zip : 44504-1130
Country : US
Telephone Number : 330-747-3910
Fax Number : 330-747-3930
Provider Business Practice Location Address
First Line : 2406 W BROADWAY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40211-1008
Country : US
Telephone Number : 502-775-1711
Fax Number : 502-443-0369
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2008
Last Update Date : 03/17/2021

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