Provider Demographics
NPI:1043839582
Name:SHAW, SHUNTOYIA YSHAY (PBT)
Entity type:Individual
Prefix:
First Name:SHUNTOYIA
Middle Name:YSHAY
Last Name:SHAW
Suffix:
Gender:F
Credentials:PBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9149 BARBARO DR APT 7108
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76140-1889
Mailing Address - Country:US
Mailing Address - Phone:682-760-1879
Mailing Address - Fax:
Practice Address - Street 1:9149 BARBARO DR APT 7108
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76140-1889
Practice Address - Country:US
Practice Address - Phone:682-760-1879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42787246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy