Provider Demographics
NPI:1194263335
Name:SHAW, VANECIA T (LPN)
Entity type:Individual
Prefix:MS
First Name:VANECIA
Middle Name:T
Last Name:SHAW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 MIRIAM RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-1715
Mailing Address - Country:US
Mailing Address - Phone:215-237-1958
Mailing Address - Fax:
Practice Address - Street 1:5525 MIRIAM RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-1715
Practice Address - Country:US
Practice Address - Phone:215-237-1958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN286676164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse