Active NPI
Kathryn Mary Shaw, PH.D., D.C.
- Chiropractor
- Port Orange, FL
National Provider Identifier
1255593240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- CH9554
- Practice address
- 3773 Fiano Dr
Port Orange, FL 32129-8623 - Phone
- (407) 421-4554
- NPI assigned
- Jun 30, 2008
- 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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | CH9554 | FL | Primary |
Addresses
Primary practice location
3773 Fiano Dr
Port Orange, FL 32129-8623
Mailing address
3773 Fiano Dr
Port Orange, FL 32129-8623
Phone (407) 421-4554
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000854600 | Medicaid | FL | |
| 88959 | Other | FL | BCBS |
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
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682899200000",
"number": "1255593240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3773 FIANO DR",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321298623",
"telephone_number": "407-421-4554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3773 FIANO DR",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321298623",
"telephone_number": "407-421-4554"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "KATHRYN",
"middle_name": "MARY",
"name_prefix": "Dr.",
"credential": "PH.D., D.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-30",
"last_updated": "2023-05-01",
"certification_date": "2023-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "FL",
"license": "CH9554",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000854600",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "88959",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Orange, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 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.