Tracie Lynn Shaw, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

A00543 Issued in MD

Practice address

3612 Woodley Rd NW
Washington, DC 20016-5033

Phone

(202) 537-5789

NPI assigned

Jul 17, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1689552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1093494080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3612 WOODLEY RD NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200165033",
            "telephone_number": "202-537-5789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3612 WOODLEY RD NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200165033",
            "telephone_number": "202-537-5789"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3411 Maple Bluff Ln",
            "address_purpose": "LOCATION",
            "city": "Bowie",
            "state": "MD",
            "postal_code": "207151625",
            "country_code": "US",
            "telephone_number": "860-377-8228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAW",
        "first_name": "TRACIE",
        "middle_name": "LYNN",
        "credential": "ATC, LAT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-17",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "VA",
            "license": "0126001356",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "AT9216",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MD",
            "license": "A00543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rhenyce A Shaw
• Roslyn Shaw
• Shawn Shaw
• Sy-Quon D. Shaw
• Timothy Shaw
• William Dean Shaw
• Shawn K. NA, DDS PLLC
• Shawn Perez Huff Sr
• Shawnelle Leola Best
• Meysam Shayegh

• Athletic Trainer in Washington, DC
• Providers in Washington, DC by specialty
• Athletic Trainer in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.