Healthcare Provider Details

I. General information

NPI: 1972426815
Provider Name (Legal Business Name): CYNTHIA R SHAW NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8106 SW 20TH ST
NORTH LAUDERDALE FL
33068-4705
US

IV. Provider business mailing address

8106 SW 20TH ST
NORTH LAUDERDALE FL
33068-4705
US

V. Phone/Fax

Practice location:
  • Phone: 954-452-2159
  • Fax: 954-916-5402
Mailing address:
  • Phone: 954-452-2159
  • Fax: 954-916-5402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11048673
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: