Provider Demographics
NPI:1376542241
Name:SHAW, DAVID BRIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BRIAN
Last Name:SHAW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007C VICTORY BLVD # 387
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-5601
Mailing Address - Country:US
Mailing Address - Phone:757-788-9141
Mailing Address - Fax:
Practice Address - Street 1:611 IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-5560
Practice Address - Country:US
Practice Address - Phone:757-788-9141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004175103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0810004175OtherCLINICAL PSYCHOLOGIST LICENSE