Provider Demographics
NPI:1144558636
Name:SHAW, BRIGITTE (PA)
Entity type:Individual
Prefix:MS
First Name:BRIGITTE
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 SUNRISE KEY BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3818
Mailing Address - Country:US
Mailing Address - Phone:954-914-3261
Mailing Address - Fax:
Practice Address - Street 1:1301 E BROWARD BLVD STE 240
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301
Practice Address - Country:US
Practice Address - Phone:954-983-1211
Practice Address - Fax:954-983-4190
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105152363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCW379ZMedicare PIN