Provider Demographics
NPI:1245240126
Name:SHAW, ROBERT H (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:SHAW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:H
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:71 WALNUT BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2073
Mailing Address - Country:US
Mailing Address - Phone:248-656-7770
Mailing Address - Fax:
Practice Address - Street 1:71 WALNUT BLVD STE 109
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2073
Practice Address - Country:US
Practice Address - Phone:248-656-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI63010076352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry