DR. NICOLE JOHNISE SHAW MD NPI 1780315473

NPI Information

  • NPI: 1780315473
  • Provider Name: DR. NICOLE JOHNISE SHAW, MD
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 4476 TWEEDY BLVD STE B
    SOUTH GATE, CA
    ZIP 90280
  • Phone: (323) 825-8300

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NPI Details

DR. Nicole Johnise Shaw, MD is a family medicine in South Gate, CA with 4 years of experience. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DR. Nicole Johnise Shaw, MD NPI is 1780315473. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4476 TWEEDY BLVD STE B
SOUTH GATE, CA
ZIP 90280-359
Phone: (323) 825-8300
Fax: (866) 372-2719

The NPI 1780315473 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/22/2022 and was last updated on 3/18/2026.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineA204378CALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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