Provider Demographics
NPI:1538134051
Name:SHAW, MONICA K (PHD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:K
Last Name:SHAW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10502 SANCREST RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4131
Mailing Address - Country:US
Mailing Address - Phone:804-741-5293
Mailing Address - Fax:
Practice Address - Street 1:10109 KRAUSE RD
Practice Address - Street 2:STE 100
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-6501
Practice Address - Country:US
Practice Address - Phone:804-751-8644
Practice Address - Fax:804-751-0648
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R363053Medicare UPIN