Chavonne Nakia Shaw

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

5017965 Issued in NC

Practice address

1357 Walter Reed Rd Ste 101
Fayetteville, NC 28304-4417

Phone

(910) 984-8311

NPI assigned

Apr 17, 2023

Sex

Female

Sole proprietor

No

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 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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Wake Spine & Pain Specialists PC

  • Pain Medicine (Anesthesiology) Physician
  • Cary, NC
  • NPI 1568696748
  Medicare reassignment NPD
• Wake Spine and Pain Specialists, PC

  • Pain Medicine (Anesthesiology) Physician
  • Winston Salem, NC
  • NPI 1376287714
  NPD

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

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681689600000",
    "number": "1174219638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "537 BELLGROVE DR",
            "city": "HOPE MILLS",
            "state": "NC",
            "postal_code": "283482795",
            "telephone_number": "843-425-4507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1357 WALTER REED RD STE 101",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283044417",
            "telephone_number": "910-984-8311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "CHAVONNE",
        "middle_name": "NAKIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-17",
        "last_updated": "2023-04-17",
        "certification_date": "2023-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5017965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawnesty Dawn Sharpe
• Sharper Images of Fayetteville, Inc
• Jeffrey Dale Shatterly, RPH
• Jennifer Shattuck, CRNA
• Tanveer Shaukat, MD
• Dayco Lashell Shaw
• Shenethia Fenner Shaw, LCMHCS, NCC
• Tomeka Davis Shaw, LPC, NCC
• Dawn Shea-Frick, LCMHC, LCAS
• Jennifer Lyn Shean, PTA

• Nurse Practitioner in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.