Laquanta S Shaw, NON TYPICAL

Primary specialty

DriverTaxonomy code 172A00000X

License

2350-45-6933 Issued in IN

Practice address

4160 Tahoe CT
Indianapolis, IN 46235-8823

Phone

(317) 627-8590

NPI assigned

Aug 14, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Good Life Home Care LLC

  • In Home Supportive Care Agency
  • Indianapolis, IN
  • NPI 1417888066
  NPD (past) Authorized official

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

{
    "created_epoch": "1565740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757980800000",
    "number": "1730735903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 S STATE AVE STE 353",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462013890",
            "telephone_number": "317-627-8590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4160 TAHOE CT",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462358823",
            "telephone_number": "317-627-8590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "LAQUANTA",
        "middle_name": "S",
        "credential": "NON TYPICAL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-14",
        "last_updated": "2025-09-16",
        "certification_date": "2025-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "IN",
            "license": "HHA0901819",
            "primary": false
        },
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "IN",
            "license": "2350-45-6933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152957",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Courtney Shaw
• Damon Shaw
• Jacob Austin Shaw, PARAMEDIC
• Kami C Shaw, PA-C
• Kimerly Shaw
• Lei Shaw, L. AC
• Rena Lachelle Shaw
• SHC, LLC
• She Stylez
• Anna Katherine Shea

• Driver in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Driver in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 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.