Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Nicole Johnise Shaw, MD

Individual provider Family Medicine Physician · NPI 1780315473

Dr. Nicole Johnise Shaw, MD is a Family Practice in South Gate, California. Qualified in 2022, 4 years ago. Licensed in California.

Years since qualifying
4
Licensed in
CA
In the registry since
2022
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

4476 Tweedy Blvd Ste B
South Gate, CA 90280-6359
Phone: (323) 825-8300
Fax: (866) 372-2719
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence A204378 (CA)

Record details

NPI number1780315473
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 22, 2022
Last updated in NPPESJune 10, 2026
Certification dateJune 10, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Accepts Medicare assignment Not indicated

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