MEDICARE: DR. SHANIQUE SHERITA SHAW AMPIAH MD

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	2084P0800X	Psychiatry Physician	ME141234	FL
2	2084P0804X	Child & Adolescent Psychiatry Physician	ME141234	FL
3	2084P0804X	Child & Adolescent Psychiatry Physician	307164	LA
4	2084P0800X	Psychiatry Physician	307164	LA

General Provider Information

NPI Number	:	1295152510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANIQUE SHERITA SHAW AMPIAH MD

Provider Business Mailing Address
First Line	:	13241 BARTRAM PARK BLVD UNIT 117
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5232
Country	:	US
Telephone Number	:	904-203-4700
Fax Number	:	844-329-0848

Provider Business Practice Location Address
First Line	:	13241 BARTRAM PARK BLVD UNIT 117
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5232
Country	:	US
Telephone Number	:	904-203-4700
Fax Number	:	844-329-0848

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

Provider Enumeration Date	:	03/25/2014
Last Update Date	:	05/12/2026

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