Provider Demographics
NPI:1992326078
Name:SHAW, SARAH N IBANEZ (DO)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:N IBANEZ
Last Name:SHAW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:NACHELLE
Other - Last Name:IBANEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UT AUSTIN DELL MEDICAL SCHOOL EM RESIDENCY PROGRAM
Mailing Address - Street 2:1400 N. I-35, SUITE 2.230
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UT AUSTIN DELL MEDICAL SCHOOL EM RESIDENCY PROGRAM
Practice Address - Street 2:1400 N. I-35, SUITE 2.230
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701
Practice Address - Country:US
Practice Address - Phone:512-324-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1709541207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine