Individual provider · Type 1 NPI

Kristian Taylor Shaw, PA-C

Medical Physician Assistant · Lakewood, OH

NPI number 1477112381 Active

Practice location

14601 Detroit Ave
Lakewood, OH 44107-4205

Call (216) 237-5500 Map

Mailing address

828 Waterford Cut
Crystal Lake, IL 60014-8506

Other practice locations

  • 828 Waterford Cut, Crystal Lake, IL 60014-8506 · (847) 306-9843

Specialties and licenses

TaxonomyCodeLicense
Behavior Technician 106S00000XNone listed
Physician Assistant 363A00000XNone listed
Medical Physician Assistant Primary 363AM0700XNone listed

Medical Physician Assistant: Definition to come...

55 other providers at this address

About NPI 1477112381

Kristian Taylor Shaw, PA-C's National Provider Identifier is 1477112381, issued on Jun 13, 2019. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Lakewood, OH. The record was last updated on May 10, 2023.