MEDICARE: MS. STACEY LYNN SHAW APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	20127	SC

General Provider Information

NPI Number	:	1093226789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STACEY LYNN SHAW APRN

Provider Business Mailing Address
First Line	:	286 JUNCO CIR
Second Line	:
City	:	LONGS
State	:	SC
Zip	:	29568-6965
Country	:	US
Telephone Number	:	843-321-5099
Fax Number	:

Provider Business Practice Location Address
First Line	:	2423 HIGHWAY 17 S
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-4343
Country	:	US
Telephone Number	:	843-919-0700
Fax Number	:	843-919-0727

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2017
Last Update Date	:	09/25/2023

Similar Medicare Providers

1578563508 — DR. ROBERT W SIMON D.C.
Practice Location Address:

2421 HIGHWAY 17 SOUTH
N MYRTLE BEACH, SC
29582-4343

Practice Phone: 843-272-7979
Practice Fax: 843-272-3534

1942213244 — SIMON CHIROPRACTIC
Practice Location Address:

2421 HIGHWAY 17 S
NORTH MYRTLE BEACH, SC
29582-4343

Practice Phone: 843-272-7979
Practice Fax: 843-272-3534

1790330066 — COUNSELING OF THE CAROLINAS
Practice Location Address:

2423 HIGHWAY 17 S STE 129
NORTH MYRTLE BEACH, SC
29582-4343

Practice Phone: 281-865-1704
Practice Fax:

1295515765 — MINDLAB LLC
Practice Location Address:

2423 HIGHWAY 17 S
NORTH MYRTLE BEACH, SC
29582-4343

Practice Phone: 843-321-5099
Practice Fax:

1134912017 — EBENEZER OF MB
Practice Location Address:

2423 HIGHWAY 17 S
NORTH MYRTLE BEACH, SC
29582-4343

Practice Phone: 843-306-9922
Practice Fax: 843-808-5020

1003790007 — CHRISTIAN FAITH HOME CARE LLC
Practice Location Address:

2423 HIGHWAY 17 S STE 32201623
NORTH MYRTLE BEACH, SC
29582-4343

Practice Phone: 910-916-4022
Practice Fax: 910-809-2327

Directions to “ MS. STACEY LYNN SHAW APRN” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.