Provider Demographics
NPI:1124903141
Name:SHAW, PATRICK (PA-C)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:SHAW
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-2902
Mailing Address - Country:US
Mailing Address - Phone:857-340-9053
Mailing Address - Fax:
Practice Address - Street 1:229 TRUMBULL ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-1501
Practice Address - Country:US
Practice Address - Phone:860-231-5420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant