MEDICARE: TENECIA 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1689540528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TENECIA SHAW

Provider Business Mailing Address
First Line	:	195 RIVER GROVE WAY APT 111
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-2139
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6820 OKEECHOBEE BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2593
Country	:	US
Telephone Number	:	561-684-3064
Fax Number	:

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

Provider Enumeration Date	:	10/16/2025
Last Update Date	:	10/16/2025

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Directions to “ TENECIA SHAW ” Practice Location

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