Provider Demographics
NPI:1992530265
Name:SHAW, JORDYN LEIGH
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:LEIGH
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 1:88 MERRYMAN RD
Mailing Address - Street 2:
Mailing Address - City:GLENBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04401-1021
Mailing Address - Country:US
Mailing Address - Phone:406-439-9880
Mailing Address - Fax:
Practice Address - Street 1:88 MERRYMAN RD
Practice Address - Street 2:
Practice Address - City:GLENBURN
Practice Address - State:ME
Practice Address - Zip Code:04401-1021
Practice Address - Country:US
Practice Address - Phone:406-439-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer