Healthcare Provider Details

I. General information

NPI: 1700710688
Provider Name (Legal Business Name): MADISON ELAINE SHAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E WASHINGTON AVE
REEDLEY CA
93654-3595
US

IV. Provider business mailing address

32872 PUMA LN
SQUAW VALLEY CA
93675-9666
US

V. Phone/Fax

Practice location:
  • Phone: 559-305-7130
  • Fax: 559-823-3775
Mailing address:
  • Phone: 559-972-0936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: