Provider Demographics
NPI:1598022261
Name:SHAW, PETRA Y (RN)
Entity type:Individual
Prefix:MRS
First Name:PETRA
Middle Name:Y
Last Name:SHAW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 E SEMORAN BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-5674
Mailing Address - Country:US
Mailing Address - Phone:407-949-8886
Mailing Address - Fax:404-358-5005
Practice Address - Street 1:1428 E SEMORAN BLVD STE 110
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5674
Practice Address - Country:US
Practice Address - Phone:407-949-8886
Practice Address - Fax:404-358-5005
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3362262163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health