Active NPI
Tracy Shabu
- Gerontology Nurse Practitioner
- Cary, NC
National Provider Identifier
1194352963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 11180114
- Practice address
- 714 Windy Peak Loop
Cary, NC 27519-1886 - Phone
- (919) 914-4097
- NPI assigned
- Mar 23, 2020
- Last updated
- Sep 29, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 11180114 | NC | Primary |
Addresses
Primary practice location
714 Windy Peak Loop
Cary, NC 27519-1886
Mailing address
714 Windy Peak Loop
Cary, NC 27519-1886
Phone (919) 914-4097
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11180114 | NC | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Theoria Medical | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790640000000",
"number": "1194352963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "714 WINDY PEAK LOOP",
"city": "CARY",
"state": "NC",
"postal_code": "275191886",
"telephone_number": "919-914-4097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "714 WINDY PEAK LOOP",
"city": "CARY",
"state": "NC",
"postal_code": "275191886",
"telephone_number": "919-914-4097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHABU",
"first_name": "TRACY",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-03-23",
"last_updated": "2026-09-29",
"certification_date": "2020-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "NC",
"license": "11180114",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cary, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.