Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | ME107446 | FL |
Y | 208600000X | Surgeon | ME107446 | FL |
N | 2086X0206X | Surgical Oncologist | MD433729 | PA |
NPI | 1063532307 |
---|---|
Provider Name | Dr. Christiana Marie Shaw |
First Address | Orlando, FL 32891-8025 |
Second Address | Gainsville, FL 32610-3003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 28/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002451200 | (05) | FL |
1021778180001 | (05) | PA |