Provider Demographics
NPI:1215801352
Name:SHAW, MARTINA L (HHA)
Entity type:Individual
Prefix:MISS
First Name:MARTINA
Middle Name:L
Last Name:SHAW
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 MILL RD APT 4H
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4748
Mailing Address - Country:US
Mailing Address - Phone:347-503-6300
Mailing Address - Fax:
Practice Address - Street 1:22 ALAN LOOP
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4460
Practice Address - Country:US
Practice Address - Phone:718-816-5448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00974643374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide