Phyllis Anita Shaw

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P021704 Issued in NC

Practice address

632 W Prospect Ave
Raeford, NC 28376-2512

Phone

(910) 875-5590

Fax

(910) 875-5008

NPI assigned

Dec 19, 2025

Sex

Female

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1766102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766966400000",
    "number": "1619832821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2062",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283764062",
            "telephone_number": "910-633-3475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "632 W PROSPECT AVE",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283762512",
            "telephone_number": "910-875-5590",
            "fax_number": "910-875-5008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "PHYLLIS",
        "middle_name": "ANITA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-12-19",
        "last_updated": "2025-12-29",
        "certification_date": "2025-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P021704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Serenity Therapeutic Services, LLC
• Kathy Sanders Settle, FNP
• James William Shaffer, PA-C
• Sharper Images of Fayetteville, Inc
• Nykichia Shamon Shaw, WHNP-BC
• Kantrell Deshawn Shelton, LCAS
• William Francis Shilkitus, PAC
• Zydet Short
• Fatimatou Sidi
• Gustavo Silveira Ribeiro, DMD

• Clinical Social Worker in Raeford, NC
• Providers in Raeford, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2025; 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.