IndividualActive
Tyana Shaw
NPI 1669199642 · Clinical & Laboratory Immunology (Internal Medicine) Physician · Antioch, CA
Provider details
- NPI number
- 1669199642
- Entity type
- Individual
- Primary specialty
- Clinical & Laboratory Immunology (Internal Medicine) PhysicianAllopathic & Osteopathic Physicians
- Sex
- Female
- Sole proprietor
- No
- License
- 207RI0001 (CA)
Mailing address
4965 Ridgeview Dr
Antioch, CA 94531-7757
Registry dates
- Enumerated
- 2022-10-20
- Last updated
- 2022-11-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.