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General NPI Number Information
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NPI Number | 1659608909
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Entity Type | Individual
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Provider Name | WELLINGTON (TONY) WILBERT SHAW PHD, NCP, CAPP, CART
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Gender | Male
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 11/06/2009
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Provider Practice Location Address
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Address Line | 3872 LONG BRANCH LANE
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City | APOPKA
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State | FL
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Zip | 32712-4790
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Country | US
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Telephone | 407-880-8916
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Fax | 407-880-8916
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Provider Business Mailing Address
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Address Line | 3872 LONG BRANCH LN
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City | APOPKA
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State | FL
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Zip | 32712-4790
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Country | US
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Telephone | 407-880-8916
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Fax | 407-880-8916
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CAPP-320, NCP-01277
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License Number State | FL
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