Healthcare Provider Details

I. General information

NPI: 1811816374
Provider Name (Legal Business Name): KASANDRA M SHAW DDS,MHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 SW 27TH AVE
OCALA FL
34471-4390
US

IV. Provider business mailing address

6149 RALEIGH ST APT 1204
ORLANDO FL
32835-2283
US

V. Phone/Fax

Practice location:
  • Phone: 352-644-7603
  • Fax:
Mailing address:
  • Phone: 407-946-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN32189
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: