Jacob Wayne Shaw, A.S, A.A.S, CPT

Primary specialty

Health EducatorTaxonomy code 174H00000X

Practice address

2603 N Rodgers Ave
Alton, IL 62002-5524

Phone

(618) 465-3298

Fax

(618) 465-3302

NPI assigned

Jul 19, 2019

Last updated

Jul 19, 2019By the provider in NPPES

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Associate of Applied Science, Associate of Science

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

{
    "created_epoch": "1563494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563494400000",
    "number": "1558914457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2603 N RODGERS AVE",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620025524",
            "telephone_number": "618-465-3298",
            "fax_number": "618-465-3302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2603 N RODGERS AVE",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620025524",
            "telephone_number": "618-465-3298",
            "fax_number": "618-465-3302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "JACOB",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "A.S, A.A.S, CPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-19",
        "last_updated": "2019-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Parth Shah, MD
• Sudha Shah
• Wei Shao, BSW
• Mary E Sharrow, LCSW
• Erica D Shaw, APN
• Madalyn Shaw
• Valarie Kathy Shaw
• Joseph Frederick Shea, DDS, MS
• Danny Sarwat Shehata, MD
• Elizabeth Jeanne Sheppard, M.S., L.C.P.C.

• Health Educator in Alton, IL
• Providers in Alton, IL by specialty
• Health Educator in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2019; 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.