MEDICARE: BRITTANY SHAW

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1295145647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY SHAW

Provider Business Mailing Address
First Line	:	4119 HIGHLAND AVE
Second Line	:	UNIT 6
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1764
Country	:	US
Telephone Number	:	918-606-7313
Fax Number	:

Provider Business Practice Location Address
First Line	:	4119 HIGHLAND AVE
Second Line	:	UNIT 6
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-1764
Country	:	US
Telephone Number	:	918-606-7313
Fax Number	:

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

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	05/06/2014

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Directions to “ BRITTANY SHAW ” Practice Location

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