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General NPI Number Information
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NPI Number | 1255627279
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Entity Type | Individual
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Provider Name | NICOLE LYNN SHAY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2011
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 721 AMERICAN AVE STE 406
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City | WAUKESHA
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State | WI
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Zip | 53188-5071
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Country | US
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Telephone | 262-928-7674
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Fax | 262-928-5580
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Provider Business Mailing Address
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Address Line | 721 AMERICAN AVE # SUIET406
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City | WAUKESHA
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State | WI
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Zip | 53188-5071
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Country | US
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Telephone | 262-928-7674
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Fax | 262-928-5580
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 3519
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS01245
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3519
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License Number State | WI
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