Provider Demographics
NPI:1407046808
Name:DAVID SHAW, PSY.D. ,P.A.
Entity Type:Organization
Organization Name:DAVID SHAW, PSY.D. ,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:561-746-6482
Mailing Address - Street 1:825 S US HIGHWAY 1
Mailing Address - Street 2:360
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5976
Mailing Address - Country:US
Mailing Address - Phone:561-746-6482
Mailing Address - Fax:561-575-3662
Practice Address - Street 1:825 S US HIGHWAY 1
Practice Address - Street 2:360
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5976
Practice Address - Country:US
Practice Address - Phone:561-746-6482
Practice Address - Fax:561-575-3662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003539103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6790Medicare PIN