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General NPI Number Information
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NPI Number | 1679430326
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Entity Type | Organization
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Legal Business Name | SHAW MINDFUL MEDICINE PLLC
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Dates
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Enumeration Date | 01/06/2026
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 701 E CATHEDRAL RD STE 45
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City | PHILADELPHIA
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State | PA
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Zip | 19128-2128
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Country | US
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Telephone | 917-575-5662
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Fax | 844-739-1051
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Provider Business Mailing Address
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Address Line | 606 GREEN MEADOW DR
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City | DOUGLASSVILLE
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State | PA
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Zip | 19518-1344
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Country | US
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Telephone | 917-575-5662
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Fax | 844-739-1051
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN WILLIAM SHAW
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Credential | NP-P, PMHNP-BC
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Telephone | 917-575-5662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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