Provider Demographics
NPI:1164230454
Name:SHAW, AUSTIN (PA)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:SHAW
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 EGRET CV
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-8422
Mailing Address - Country:US
Mailing Address - Phone:215-740-2779
Mailing Address - Fax:
Practice Address - Street 1:205 MAIN ST
Practice Address - Street 2:
Practice Address - City:AUMSVILLE
Practice Address - State:OR
Practice Address - Zip Code:97325-9018
Practice Address - Country:US
Practice Address - Phone:503-749-4734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant