MEDICARE: LAURA BETH SHAO PA-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	363A00000X	Physician Assistant	1955	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376848689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA BETH SHAO PA-C

Provider Business Mailing Address
First Line	:	PO BOX 720094
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73070-4072
Country	:	US
Telephone Number	:	405-620-2870
Fax Number	:	855-538-3095

Provider Business Practice Location Address
First Line	:	1201 MAGNOLIA CT STE 109
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-1433
Country	:	US
Telephone Number	:	405-759-4155
Fax Number	:	855-538-3095

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

Provider Enumeration Date	:	01/18/2011
Last Update Date	:	09/02/2025

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