Provider Demographics
NPI:1972682870
Name:SHAW, MANDY L (MD,)
Entity type:Individual
Prefix:DR
First Name:MANDY
Middle Name:L
Last Name:SHAW
Suffix:
Gender:
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:JULESBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80737-1121
Mailing Address - Country:US
Mailing Address - Phone:970-474-3323
Mailing Address - Fax:970-474-2758
Practice Address - Street 1:900 CEDAR ST
Practice Address - Street 2:
Practice Address - City:JULESBURG
Practice Address - State:CO
Practice Address - Zip Code:80737-1121
Practice Address - Country:US
Practice Address - Phone:308-249-6600
Practice Address - Fax:970-474-2758
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEP00253777OtherRAILROAD MEDICARE
NE30482OtherBCBS OF NEBRASKA
NE279052Medicare PIN
NE30482OtherBCBS OF NEBRASKA