MEDICARE: MRS. NANCY SHAW PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	846	AL

General Provider Information

NPI Number	:	1689992778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY SHAW PHD

Provider Business Mailing Address
First Line	:	6346 GENE TERRY ROAD
Second Line	:
City	:	COTTONWOOD
State	:	AL
Zip	:	36320
Country	:	US
Telephone Number	:	334-699-8743
Fax Number	:	334-699-8748

Provider Business Practice Location Address
First Line	:	6346 GENE TERRY RD
Second Line	:
City	:	COTTONWOOD
State	:	AL
Zip	:	36320-4253
Country	:	US
Telephone Number	:	334-699-8743
Fax Number	:	334-699-8748

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2010
Last Update Date	:	05/13/2010

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