Active NPI
Shihying Sherry Shaw, PSY.D.
- Clinical Psychologist
- Lake Forest, CA
National Provider Identifier
1124348768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY26722
- Practice address
- 26632 Towne Centre Dr Ste 300
Lake Forest, CA 92610-2814 - Phone
- (949) 354-3549
- NPI assigned
- Jun 6, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Clinical Psychologist | 103TC0700X | PSY26722 | CA | Primary |
Addresses
Primary practice location
26632 Towne Centre Dr Ste 300
Lake Forest, CA 92610-2814
Mailing address
26632 Towne Centre Dr Ste 300
Lake Forest, CA 92610-2814
Phone (949) 354-3549
Other names 1
- Sherry Shaw
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective May 24, 2021 through May 24, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY26722 | CA | MD | Clinical Psychologist |
| 26722 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676592000000",
"number": "1124348768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "26632 TOWNE CENTRE DR STE 300",
"city": "LAKE FOREST",
"state": "CA",
"postal_code": "926102814",
"telephone_number": "949-354-3549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "26632 TOWNE CENTRE DR STE 300",
"city": "LAKE FOREST",
"state": "CA",
"postal_code": "926102814",
"telephone_number": "949-354-3549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "SHIHYING",
"middle_name": "SHERRY",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-06-06",
"last_updated": "2023-02-17",
"certification_date": "2023-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY26722",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SHERRY",
"last_name": "SHAW",
"credential": "PSY.D.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Lake Forest, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.