KIMBERLY DANIELLE SHAW (NPI# 1942454186) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942454186 |
| Entity Type | Individual |
| Full Name | KIMBERLY DANIELLE SHAW |
| Other Name | KIMBERLY DANIELLE YOUNG |
| Credential | PA-C |
| Practice Address |
3201 S Wallace St Chicago IL 60616-3501 |
| Mailing Address |
20110 Governors Hwy Olympia Fields IL 60461-1030 |
| Practice Telephone | 3123261615 |
| Practice Fax Number | 3123263910 |
| Mailing Telephone | 7087477960 |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2008-11-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 085-003355 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS | 01616617 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083274328 | Kimberly Scott Shaw | Marriage & Family Therapist | 1866 Clayton Rd Ste 200, Concord, CA 94520-2505 | 2019-06-18 |
| 1962967828 | Kimberly Shaw | Specialist/Technologist | 3202 Veterans Stadium Dr, Troy, AL 36082-0001 | 2019-02-05 |
| 1992157879 | Kimberly Shaw | Social Worker | 18 Constitution Dr Ste 5, Bedford, NH 03110-6076 | 2016-07-05 |
| 1821361551 | Kimberly Shaw | Social Worker | 623 E 100 S, Salt Lake City, UT 84102-1103 | 2012-02-10 |
| 1447850086 | Kimberly Shaw | Pharmacist | 2750 W University Dr, Denton, TX 76201-1628 | 2020-10-30 |
| 1467854042 | Kimberly C. Shaw | Registered Nurse | 6500 Hospital Dr, Family Medicine, Hannibal, MO 63401-6890 | 2014-09-25 |
| 1578963302 | Kimberly Neibaur Shaw | Counselor | 12040 98th Ave Ne, Suite 204, Kirkland, WA 98034-4290 | 2014-08-29 |
| 1205116431 | Kimberly Ann Shaw | Developmental Therapist | 100 Erdman Way, Leominster, MA 01453-1804 | 2011-08-19 |
| 1124307061 | Kimberly Marie Shaw | Pharmacist | 7909 S Hardy Dr, Tempe, AZ 85284-1112 | 2011-08-09 |
| 1689738064 | Kimberly Shaw | Social Worker | 17900 Linden Blvd, St. Albans, NY 11435 | 2006-12-20 |
| Street Address |
3201 S WALLACE ST |
| City | CHICAGO |
| State | IL |
| Zip Code | 60616-3501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164417291 | Snehal K Bhavsar | Pharmacist | 3201 S Wallace St, Chicago, IL 60616-3501 | 2005-09-14 |
| 1962973503 | Solo Eye Care & Eyewear Gallery, LLC | Optometrist | 3201 S Wallace St, Chicago, IL 60616-3501 | 2018-12-07 |
| 1275035180 | Shawn Lin Dds PC | Clinic/Center | 3201 S Wallace St, Chicago, IL 60616-3501 | 2018-03-07 |
| 1003360272 | Shawn Lin | Dentist | 3201 S Wallace St, Chicago, IL 60616-3501 | 2016-08-05 |
| 1124330295 | Bridgeport Family Medical Center S.c. | General Practice | 3201 S Wallace St, Chicago, IL 60616-3501 | 2010-07-06 |
| 1588983332 | Bridgeport Family Medical Center S.c. | Family Medicine | 3201 S Wallace St, Chicago, IL 60616-3501 | 2010-05-19 |
| 1982806279 | Edward Haochuan Wang | Internal Medicine | 3201 S Wallace St, Chicago, IL 60616-3501 | 2007-05-31 |
| 1699812487 | Midwest Physician Group Ltd | Family Medicine | 3201 S Wallace St, Chicago, IL 60616-3501 | 2007-01-31 |
| 1437206588 | Bridgeport Pharmacy Inc | Pharmacy | 3201 S Wallace St, Chicago, IL 60616-3501 | 2007-01-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558993758 | King Dental, PC | Clinic/Center | 3425 S King Dr, Chicago, IL 60616 | 2020-02-06 |
| 1386286144 | Anais Karel Jackson-gonzalez | Acupuncturist | 2018 S. Michigan Ave., Chicago, IL 60616 | 2019-10-14 |
| 1215499777 | Mashaal F Ikram | Student in an Organized Health Care Education/Training Program | Mercy Hospital and Medical Center, 2525 South Michigan Avenue, Chicago, IL 60616 | 2019-04-03 |
| 1891254223 | Towayn Heaven | Acupuncturist | 2018 S Michigan Ave, Chicago, IL 60616 | 2019-03-15 |
| 1689131518 | Abhishek Santos Pandya | Internal Medicine | 2525 S Michigan Ave., Mercy Hospital and Medical Center, Chicago, IL 60616 | 2019-02-27 |
| 1144703992 | Katelyn Michelle St Martin | Physician Assistant | 2850 S Michigan Ave Ste 100, Chicago, IL 60616 | 2018-09-07 |
| 1902383953 | Healing Empowering & Learning Professionals LLC | Clinic/Center | 2930 S Michigan Ave Ste 100, Chicago, IL 60616 | 2018-07-23 |
| 1437644812 | Puja Bhagwakar | Dentist | 1620 S Michigan Ave Unit 704, Chicago, IL 60616 | 2018-06-27 |
| 1821589110 | David Alexander Sousa Frias | Internal Medicine | 2525 Michigan Ave, Mercy Hospital At Medical Center, Chicago, IL 60616 | 2018-05-23 |
| 1508394933 | Awad Eyecare Sc | Optometrist | 1845 S Michigan Ave Unit 1803, Chicago, IL 60616 | 2017-05-30 |
| Find all providers in zip 60616 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508470709 | Bryan Ying Wong | Physician Assistant | 3420 S Morgan St Apt 2e, Chicago, IL 60608-6904 | 2020-09-04 |
| 1245858117 | Emily Victoria Headley | Physician Assistant | 1431 N Western Ave Ste 134, Chicago, IL 60622-1797 | 2020-07-08 |
| 1548884547 | Crystal Afua Amoah | Physician Assistant | 1665 N Orchard St Apt 104, Chicago, IL 60614-5385 | 2020-06-04 |
| 1841814274 | Zubair Aslam Khan | Physician Assistant | 3037 W Wilson Ave Apt 2w, Chicago, IL 60625-4345 | 2020-06-01 |
| 1659991818 | Taylor Nicole Anderson | Physician Assistant | 25 W Randolph St Apt 603, Chicago, IL 60601-3514 | 2020-04-17 |
| 1720616444 | Melanie Doretti | Physician Assistant | 3052 N Seminary Ave Apt 2r, Chicago, IL 60657-6788 | 2020-03-29 |
| 1154958544 | Joerissa Gearlds | Physician Assistant | 5645 W Addison St Rm 353, Chicago, IL 60634-4403 | 2020-03-25 |
| 1932736816 | Taylor Evan Fisher | Physician Assistant | 3033 N Sheridan Rd Apt 301, Chicago, IL 60657-5578 | 2020-03-23 |
| 1285260844 | Krista A Saum | Physician Assistant | 661 W Sheridan Rd Apt 601, Chicago, IL 60613-3311 | 2020-03-16 |
| 1386278430 | Adara Simonelli | Physician Assistant | 6317 S Lorel Avenue, Chicago, IL 60638 | 2020-02-27 |
| Find all providers in CHICAGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.