Provider Demographics
NPI:1427510288
Name:SHAW, DARINA MARIE
Entity type:Individual
Prefix:
First Name:DARINA
Middle Name:MARIE
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 1:2616 YOUNGSTOWN LOCKPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:RANSOMVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14131
Mailing Address - Country:US
Mailing Address - Phone:716-208-0102
Mailing Address - Fax:
Practice Address - Street 1:2476 MOORE ROAD
Practice Address - Street 2:
Practice Address - City:RANSOMVILLE
Practice Address - State:NY
Practice Address - Zip Code:14131
Practice Address - Country:US
Practice Address - Phone:716-208-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324738164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse