Provider Demographics
NPI:1760679690
Name:SHAW, PARVONAE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PARVONAE
Middle Name:
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 1:235 VILLAGE GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-0093
Mailing Address - Country:US
Mailing Address - Phone:954-205-4369
Mailing Address - Fax:
Practice Address - Street 1:235 VILLAGE GRANDE DR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-0093
Practice Address - Country:US
Practice Address - Phone:954-205-4369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2023-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist