Rebecca Anne Shaw, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

262350 Issued in AZ

Practice address

1140 E Greenway St Ste 1
Mesa, AZ 85203-4359

Phone

(480) 296-4742

Fax

(480) 805-2184

NPI assigned

Jan 17, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: 2ndchancetreatmentcenters.rebeccashaw@154160.advancedmd-direct.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• I Am Wellness Az LLC

  • Adult Medicine Physician
  • Chandler, AZ
  • NPI 1184354532
  Medicare reassignment NPD
• I Am Wellness Az LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1376372078
  NPD (past)
• I Am Wellness Az LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1487483186
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765324800000",
    "number": "1003405739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1131 S PHEASANT DR",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852963062",
            "telephone_number": "480-296-4742",
            "fax_number": "480-805-2184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 E GREENWAY ST STE 1",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852034359",
            "telephone_number": "480-296-4742",
            "fax_number": "480-805-2184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "REBECCA",
        "middle_name": "ANNE",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-17",
        "last_updated": "2025-12-10",
        "certification_date": "2025-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AZ",
            "license": "262350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shashikala Ameneni PLLC
• Jonathon Shasteen, PHD, NCSP, LP
• Keith Alan Shaull, PT
• Shauna Brown, LLC
• Hollis Earl Shaw, M.D.
• Tori A Shaw, FNP
• Tracy A Shaw
• Shawna Hale LLC
• Shaylar Hatch, D.M.D., P.C.
• Shaythecoachacupuncture

• Psychiatric/Mental Health Nurse Practitioner in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.