Active NPI
Amanda Shaw, PHD
- Clinical Psychologist
- Rochester, NY
National Provider Identifier
1356834378
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 022686-1
- Practice address
- 247 Park Ave
Rochester, NY 14607-2723 - Phone
- (505) 402-3639
- Fax
- (585) 244-0629
- NPI assigned
- Jun 13, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 022686-1 | NY | Primary |
Addresses
Primary practice location
247 Park Ave
Rochester, NY 14607-2723
Mailing address
247 Park Ave
Rochester, NY 14607-2723
Phone (505) 402-3639
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 022686-1 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1528848000000",
"number": "1356834378",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "247 PARK AVE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146072723",
"telephone_number": "505-402-3639",
"fax_number": "585-244-0629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "247 PARK AVE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146072723",
"telephone_number": "505-402-3639",
"fax_number": "585-244-0629"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "AMANDA",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-06-13",
"last_updated": "2018-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "022686-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rochester, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.