MEDICARE: LAURA A SHAW FNP-C

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	R220524	MD

General Provider Information

NPI Number	:	1184322653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA A SHAW FNP-C

Provider Business Mailing Address
First Line	:	11765 BRIGHT PSGE
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-4347
Country	:	US
Telephone Number	:	505-238-5593
Fax Number	:

Provider Business Practice Location Address
First Line	:	8820 COLUMBIA 100 PKWY STE 400
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-2175
Country	:	US
Telephone Number	:	443-393-9600
Fax Number	:

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

Provider Enumeration Date	:	02/23/2023
Last Update Date	:	08/11/2025

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