Provider Demographics
NPI:1114598950
Name:SHAW, CATHERINE DEWALD (PA-C)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:DEWALD
Last Name:SHAW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 WHITMIRE RD
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-1426
Mailing Address - Country:US
Mailing Address - Phone:864-855-2411
Mailing Address - Fax:864-855-2413
Practice Address - Street 1:115 WHITMIRE RD
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-1426
Practice Address - Country:US
Practice Address - Phone:864-855-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4429363A00000X
NC0010-11421363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant