MEDICARE: DR. PAULA SHAW PSYD

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	103TC0700X	Clinical Psychologist	PY10202	FL
2	103T00000X	Psychologist	PY10202	FL

General Provider Information

NPI Number	:	1922585454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULA SHAW PSYD

Provider Business Mailing Address
First Line	:	6803 LAKE WORTH RD STE 215
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33467-2979
Country	:	US
Telephone Number	:	561-207-7625
Fax Number	:

Provider Business Practice Location Address
First Line	:	6803 LAKE WORTH RD STE 215
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33467-2979
Country	:	US
Telephone Number	:	561-207-7625
Fax Number	:

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

Provider Enumeration Date	:	07/27/2018
Last Update Date	:	11/08/2024

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