| NPI | 1255587523 |
|---|---|
| Former Name | MANDI MICHELLE SHAW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9108747) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CO 2464) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2016-03-18 |