Provider Demographics
NPI:1558840470
Name:SHAW, KIRSTEN ELISE (MD)
Entity type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:ELISE
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1510 E MAIN ST STE 104C
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4825
Mailing Address - Country:US
Mailing Address - Phone:805-928-5767
Mailing Address - Fax:805-349-0222
Practice Address - Street 1:1510 E MAIN ST STE 104C
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4825
Practice Address - Country:US
Practice Address - Phone:805-928-5767
Practice Address - Fax:805-349-0222
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN66783207R00000X
CAA202815207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine