Healthcare Provider Details

I. General information

NPI: 1033729959
Provider Name (Legal Business Name): JULIET N/A SHAW APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2020
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NE 167TH ST
NORTH MIAMI BEACH FL
33162-3402
US

IV. Provider business mailing address

9221 NW 14TH CT UNIT 260
PEMBROKE PINES FL
33024-4545
US

V. Phone/Fax

Practice location:
  • Phone: 305-432-9565
  • Fax: 305-432-9567
Mailing address:
  • Phone: 954-471-7278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN9379405
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11009003
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11009003
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: