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NPI Code Detail

MEDICARE: DOUGLAS LYNDE SHAW PSY.D.

MEDICARE: DOUGLAS LYNDE SHAW PSY.D.
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
1103TC0700XClinical Psychologist37052TX

General Provider Information

NPI Number : 1780853150
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS LYNDE SHAW PSY.D.
Provider Business Mailing Address
First Line : 2200 S PLEASANT VALLEY RD
Second Line : SUITE 918
City : AUSTIN
State : TX
Zip : 78741-4688
Country : US
Telephone Number : 512-839-5155
Fax Number :
Provider Business Practice Location Address
First Line : 2830 REAL ST
Second Line :
City : AUSTIN
State : TX
Zip : 78722-1715
Country : US
Telephone Number : 512-448-1840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/29/2008
Last Update Date : 08/02/2016

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