Provider Demographics
NPI:1730453390
Name:SHAW, MATTHEW (PA-C)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:SHAW
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:2490 HOSPITAL DR
Mailing Address - Street 2:STE 311
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4126
Mailing Address - Country:US
Mailing Address - Phone:650-962-4690
Mailing Address - Fax:650-962-4507
Practice Address - Street 1:100 S SAN MATEO DR
Practice Address - Street 2:STE 400
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3805
Practice Address - Country:US
Practice Address - Phone:650-696-4107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-29
Last Update Date:2017-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA22091363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant