MEDICARE: TORI A SHAW FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	315937	AZ

General Provider Information

NPI Number	:	1144042342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TORI A SHAW FNP

Provider Business Mailing Address
First Line	:	3926 E SIDESADDLE RD
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85140-1637
Country	:	US
Telephone Number	:	520-709-8902
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 S. POWER RD
Second Line	:	SUITE 101
City	:	MESA
State	:	AZ
Zip	:	85206
Country	:	US
Telephone Number	:	480-214-0045
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2024
Last Update Date	:	12/12/2025

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