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NPI Code Detail

MEDICARE: BRITTAINY SHAW LPP

MEDICARE: BRITTAINY SHAW LPP
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
1103T00000XPsychologist0835KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000502475OTHERANTHEM BCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487753158
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRITTAINY SHAW LPP
Provider Business Mailing Address
First Line : 312 S 4TH ST STE 700
Second Line :
City : LOUISVILLE
State : KY
Zip : 40202-3046
Country : US
Telephone Number : 614-390-3387
Fax Number : 614-408-8892
Provider Business Practice Location Address
First Line : 312 S 4TH ST STE 700
Second Line :
City : LOUISVILLE
State : KY
Zip : 40202-3046
Country : US
Telephone Number : 614-390-3387
Fax Number : 614-408-8892
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 06/17/2019

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Directions to “ BRITTAINY SHAW LPP” Practice Location

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