Individual provider Active NPI

Shenna J Shaw, NP

  • Nurse Practitioner
  • Concord, NC
National Provider Identifier
1053783134
Registry record updated Mar 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
500813 Issued in NC
Practice address
1085 NE Gateway CT NE Ste 100
Concord, NC 28025-2411
Phone
(704) 707-2200
Fax
(704) 707-2203
NPI assigned
Oct 28, 2015
Last updated
Mar 31, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 500813 NC Primary

Addresses

Primary practice location

1085 NE Gateway CT NE Ste 100
Concord, NC 28025-2411

Mailing address

1518 E 3Rd St Ste 250
Charlotte, NC 28204-3192
Phone (704) 944-6330

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20151221000950 NC Practitioner - Nurse Practitioner 2163723925 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Urology Specialists of the Carolinas PLLCGroup PAC ID 0648178020, 78 clinicians

Practice addresses (Care Compare)

1085 NE Gateway CT NE
Suite 100
Concord, NC 28025-2407
Phone (704) 707-2200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
500813NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Urology Specialists of the Carolinas CurrentSince Feb 9, 2026 Accepting new patients
Carolina Digestive Health Associates, PA Past Accepting new patients
Greater Charlotte Support Services, PLLC PastSince Dec 12, 2025 Accepting new patients

Locations

101 E Wt Harris Blvd
Ste 5201
Charlotte, NC 28262
Phone (704) 547-1495

Organizations & group practices 4

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

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1445990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774915200000",
    "number": "1053783134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1518 E 3RD ST STE 250",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043192",
            "telephone_number": "704-944-6330",
            "fax_number": "704-337-8387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1085 NE GATEWAY CT NE STE 100",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252411",
            "telephone_number": "704-707-2200",
            "fax_number": "704-707-2203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "SHENNA",
        "middle_name": "J",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-10-28",
        "last_updated": "2026-03-31",
        "certification_date": "2026-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "500813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.