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NPI Code Detail

MEDICARE: ASHLEY LYNN SHAW

MEDICARE: ASHLEY LYNN SHAW
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
1390200000XStudent in an Organized Health Care Education/Training ProgramFL

General Provider Information

NPI Number : 1942157573
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY LYNN SHAW
Provider Business Mailing Address
First Line : 2691 COLLEGE ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32204-3571
Country : US
Telephone Number : 904-309-2217
Fax Number :
Provider Business Practice Location Address
First Line : 800 PRUDENTIAL DR
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-8211
Country : US
Telephone Number : 904-202-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2026
Last Update Date : 03/12/2026

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