MEDICARE: CHANTELLE SHAW DO

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	2084P0804X	Child & Adolescent Psychiatry Physician	T8942	TX

General Provider Information

NPI Number	:	1447711585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANTELLE SHAW DO

Provider Business Mailing Address
First Line	:	3120 SOUTHWEST FWY
Second Line	:	STE 101 PMB 173354
City	:	HOUSTON
State	:	TX
Zip	:	77098-4520
Country	:	US
Telephone Number	:	832-793-7942
Fax Number	:	800-352-9936

Provider Business Practice Location Address
First Line	:	3120 SOUTHWEST FWY
Second Line	:	STE 101 PMB 173354
City	:	HOUSTON
State	:	TX
Zip	:	77098-4520
Country	:	US
Telephone Number	:	832-793-7942
Fax Number	:	800-352-9936

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

Provider Enumeration Date	:	03/29/2019
Last Update Date	:	11/06/2025

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