MEDICARE: MS. SANDRA C SHAW L.C.S.W./A.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS# 10881	CA

General Provider Information

NPI Number	:	1093750192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA C SHAW L.C.S.W./A.C.S.W.

Provider Business Mailing Address
First Line	:	820 CHERRY LN
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-1701
Country	:	US
Telephone Number	:	916-967-0778
Fax Number	:	916-726-5195

Provider Business Practice Location Address
First Line	:	7777 GREENBACK LN
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-5800
Country	:	US
Telephone Number	:	916-967-0778
Fax Number	:	916-726-5195

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	07/08/2007

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