Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC007254L | PA |
NPI | 1003937343 |
---|---|
Provider Name | Dr. Conan J. Shaw |
First Address | Cranberry Twp, PA 16066-2816 |
Second Address | Cranberry Twp, PA 16066-6430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |