Healthcare Provider Details

I. General information

NPI: 1760687354
Provider Name (Legal Business Name): STEPHANIE SHAW M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 DEEPWOOD DR SUITE 104
ROUND ROCK TX
78681-4944
US

IV. Provider business mailing address

6500 NORTH MOPAC EXPRESSWAY BUILDING 3, SUITE 200
AUSTIN TX
78731
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-8400
  • Fax: 512-458-8593
Mailing address:
  • Phone: 512-458-8400
  • Fax: 512-458-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberM6880
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: