MEDICARE: HALEY ALLYNE 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1790595742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY ALLYNE SHAW

Provider Business Mailing Address
First Line	:	2310 SKYLINE DR UNIT 11
Second Line	:
City	:	LOWELL
State	:	MA
Zip	:	01854-1443
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 SKYLINE DR UNIT 11
Second Line	:
City	:	LOWELL
State	:	MA
Zip	:	01854-1443
Country	:	US
Telephone Number	:	603-809-9806
Fax Number	:

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

Provider Enumeration Date	:	01/11/2025
Last Update Date	:	04/24/2025

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Directions to “ HALEY ALLYNE SHAW ” Practice Location

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