Provider Demographics
NPI:1609217280
Name:SHAW, CHRISSYL KANDIS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISSYL
Middle Name:KANDIS
Last Name:SHAW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 NW 5TH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2120
Mailing Address - Country:US
Mailing Address - Phone:954-583-4568
Mailing Address - Fax:954-583-4528
Practice Address - Street 1:4121 NW 5TH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2120
Practice Address - Country:US
Practice Address - Phone:954-583-4568
Practice Address - Fax:954-583-4528
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8765103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist