MEDICARE: SERENA 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	171100000X	Acupuncturist	ACU.0002198	CO

General Provider Information

NPI Number	:	1669991832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERENA SHAW

Provider Business Mailing Address
First Line	:	2845 WYANDOT ST APT B
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-4315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2845 WYANDOT ST APT B
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-4315
Country	:	US
Telephone Number	:	720-295-4594
Fax Number	:

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

Provider Enumeration Date	:	09/19/2017
Last Update Date	:	09/19/2017

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Directions to “ SERENA SHAW ” Practice Location

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