Healthcare Provider Details

I. General information

NPI: 1053783134
Provider Name (Legal Business Name): SHENNA J SHAW NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2015
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 NE GATEWAY CT NE STE 100
CONCORD NC
28025-2411
US

IV. Provider business mailing address

1518 E 3RD ST STE 250
CHARLOTTE NC
28204-3192
US

V. Phone/Fax

Practice location:
  • Phone: 704-707-2200
  • Fax: 704-707-2203
Mailing address:
  • Phone: 704-944-6330
  • Fax: 704-337-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number500813
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: