Active NPI
Colleen R. Shaw, M.D.
- Pediatrics Physician
- Sheridan, WY
National Provider Identifier
1376840587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- TL4426
- Practice address
- 916 Jackson Avenue
Sheridan, WY 82801 - Phone
- (307) 675-5555
- Fax
- (307) 675-5599
- NPI assigned
- Feb 24, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A114032 | CA | |
| Pediatrics Physician | 208000000X | TL4426 | WY | Primary |
Addresses
Primary practice location
916 Jackson Avenue
Sheridan, WY 82801
Mailing address
916 Jackson Avenue
Sheridan, WY 82801
Phone (307) 675-5555
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A114032 | CA | MD | Pediatrics Physician |
| TL4426 | WY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298505600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533081600000",
"number": "1376840587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "916 JACKSON AVENUE",
"city": "SHERIDAN",
"state": "WY",
"postal_code": "82801",
"telephone_number": "307-675-5555",
"fax_number": "307-675-5599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "916 JACKSON AVENUE",
"city": "SHERIDAN",
"state": "WY",
"postal_code": "82801",
"telephone_number": "307-675-5555",
"fax_number": "307-675-5599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "COLLEEN",
"middle_name": "R.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-02-24",
"last_updated": "2018-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A114032",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WY",
"license": "TL4426",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sheridan, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.