MEDICARE: VERCONIA 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	3747P1801X	Personal Care Attendant
2	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1578237376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERCONIA SHAW

Provider Business Mailing Address
First Line	:	2000 EAST LAMAR BOULEVARD
Second Line	:	SUITE 600 #1181
City	:	ARLINGTON
State	:	TX
Zip	:	76006
Country	:	US
Telephone Number	:	682-999-9983
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 EAST LAMAR BOULEVARD
Second Line	:	SUITE 600 #1181
City	:	ARLINGTON
State	:	TX
Zip	:	76006
Country	:	US
Telephone Number	:	682-999-9983
Fax Number	:

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

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	08/04/2021

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Directions to “ VERCONIA SHAW ” Practice Location

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