Active NPI
Marlene Marie Shaw-Gallagher, PA
- Physician Assistant
- Livonia, MI
National Provider Identifier
1891022034
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601005675
- Practice address
- 19900 Haggerty Rd
Suite 106
Livonia, MI 48152-1052 - Phone
- (734) 432-7870
- Fax
- (734) 432-7871
- NPI assigned
- Nov 9, 2009
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601005675 | MI | Primary |
Addresses
Primary practice location
19900 Haggerty Rd
Suite 106
Livonia, MI 48152-1052
Mailing address
3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601005675 | MI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1257724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601251200000",
"number": "1891022034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3621 S STATE ST",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481081633",
"telephone_number": "734-647-5299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19900 HAGGERTY RD",
"address_2": "SUITE 106",
"city": "LIVONIA",
"state": "MI",
"postal_code": "481521052",
"telephone_number": "734-432-7870",
"fax_number": "734-432-7871"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW-GALLAGHER",
"first_name": "MARLENE",
"middle_name": "MARIE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-11-09",
"last_updated": "2020-09-28",
"certification_date": "2020-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601005675",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livonia, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.