Healthcare Provider Details

I. General information

NPI: 1609427194
Provider Name (Legal Business Name): APRIL PATRICIA SHAW PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14327 BLANCO RD
SAN ANTONIO TX
78216-7723
US

IV. Provider business mailing address

13734 CORINTH
UNIVERSAL CITY TX
78148-2620
US

V. Phone/Fax

Practice location:
  • Phone: 210-245-7933
  • Fax:
Mailing address:
  • Phone: 714-658-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number58989
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA14903
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: