Provider Demographics
NPI:1063809119
Name:SHAW, NAYAKA
Entity type:Individual
Prefix:
First Name:NAYAKA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 GOLDEN SHORES DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-7616
Mailing Address - Country:US
Mailing Address - Phone:713-510-3249
Mailing Address - Fax:281-254-7860
Practice Address - Street 1:5005 ALLUM RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77045-2209
Practice Address - Country:US
Practice Address - Phone:713-510-3249
Practice Address - Fax:281-254-7860
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor