Healthcare Provider Details

I. General information

NPI: 1154309557
Provider Name (Legal Business Name): CHARLENE G. SHAW D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5951 COLONIAL DR
MARGATE FL
33063-5661
US

IV. Provider business mailing address

PO BOX 734951
CHICAGO IL
60673-4951
US

V. Phone/Fax

Practice location:
  • Phone: 872-231-3162
  • Fax: 561-367-7886
Mailing address:
  • Phone: 702-899-0595
  • Fax: 702-977-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS8413
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: