Provider Demographics
NPI:1689992778
Name:SHAW, NANCY (PHD)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
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 1:6346 GENE TERRY ROAD
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:36320
Mailing Address - Country:US
Mailing Address - Phone:334-699-8743
Mailing Address - Fax:334-699-8748
Practice Address - Street 1:6346 GENE TERRY RD
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AL
Practice Address - Zip Code:36320-4253
Practice Address - Country:US
Practice Address - Phone:334-699-8743
Practice Address - Fax:334-699-8748
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL846103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist