Healthcare Provider Details

I. General information

NPI: 1942552930
Provider Name (Legal Business Name): DAVID ABRAHAM SHWALB PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 LIELMANIS
HURLBURT FIELD FL
32544
US

IV. Provider business mailing address

113 LIELMANIS ATTN: LT COL SHWALB
HURLBURT FIELD FL
32544
US

V. Phone/Fax

Practice location:
  • Phone: 850-881-4237
  • Fax:
Mailing address:
  • Phone: 850-881-4237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP03386
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: