Provider Demographics
NPI:1215575428
Name:SHAW, CARMALITA YVETTE
Entity type:Individual
Prefix:
First Name:CARMALITA
Middle Name:YVETTE
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 1:1310 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AL
Mailing Address - Zip Code:36756-3218
Mailing Address - Country:US
Mailing Address - Phone:334-628-2651
Mailing Address - Fax:334-628-2656
Practice Address - Street 1:1310 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AL
Practice Address - Zip Code:36756-3218
Practice Address - Country:US
Practice Address - Phone:334-683-2073
Practice Address - Fax:334-683-2077
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator