Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 239174 | NY |
NPI | 1548208820 |
---|---|
Provider Name | Jana Shaw |
First Address | Watertown, NY 13601-5364 |
Second Address | Watertown, NY 13601-2504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 20/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02462559 | (05) | NY |
239174 | LICENSE NUMBER (01) | NY |