Provider Demographics
NPI:1164217618
Name:SHAW, ANGELA KAY
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:KAY
Last Name:SHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:KAY
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:453 DICKINSON AVE
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2317
Mailing Address - Country:US
Mailing Address - Phone:419-296-2824
Mailing Address - Fax:
Practice Address - Street 1:453 DICKINSON AVE
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2317
Practice Address - Country:US
Practice Address - Phone:419-296-2824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker