Tiffany Shaw, LAT, C.PH.T

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT3981 Issued in TX

Practice address

1200 Boyd Rd
Azle, TX 76020-2522

Phone

(817) 444-5555

NPI assigned

Jul 21, 2016

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": "1469059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469059200000",
    "number": "1689027039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 GOLFERS WAY",
            "city": "AZLE",
            "state": "TX",
            "postal_code": "760203061",
            "telephone_number": "817-694-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 BOYD RD",
            "city": "AZLE",
            "state": "TX",
            "postal_code": "760202522",
            "telephone_number": "817-444-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "TIFFANY",
        "name_prefix": "Mrs.",
        "credential": "LAT, C.PH.T",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-07-21",
        "last_updated": "2016-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": "AT3981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Segue Health of Texas PLLC
• Sarah Amily Sepulveda Farrar, FNP-C
• Melissa Sepulveda, CPC-A
• Andrew Sewell, DPT
• Kavita Sanjiv Shah, M.D.
• Shiny Studio PLLC
• Silver Creek Al LLC
• Silver Creek Place LTD.
• Richard J Smiley, PTA
• Heather M Smith, COTA

• Athletic Trainer in Azle, TX
• Providers in Azle, TX by specialty
• Athletic Trainer in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2016; 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.