MEDICARE: SHAWN 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

General Provider Information

NPI Number	:	1689307456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN SHAW

Provider Business Mailing Address
First Line	:	3020 GAINESVILLE ST SE APT C487
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-2516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4262 E CAPITOL ST NE APT 40
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20019-4487
Country	:	US
Telephone Number	:	202-683-0980
Fax Number	:

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

Provider Enumeration Date	:	07/07/2022
Last Update Date	:	07/07/2022

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Directions to “ SHAWN SHAW ” Practice Location

Language	Start Address	Practice Location

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