MEDICARE: DAPHNA JEAN SHAW

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	363LP0200X	Pediatric Nurse Practitioner	AP134647	TX

General Provider Information

NPI Number	:	1245773142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAPHNA JEAN SHAW

Provider Business Mailing Address
First Line	:	1935 MEDICAL DISTRICT DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-7701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 MEDICAL DISTRICT DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235
Country	:	US
Telephone Number	:	847-867-9457
Fax Number	:

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

Provider Enumeration Date	:	11/24/2016
Last Update Date	:	05/08/2025

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