Mary Leonie Richard Shaw, RN
Individual provider Active NPI Psychiatry Physician · Cullman, AZ
NPI 1497769228 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1497769228
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 1019709 (AL)
- Practice address
- 409 Second Ave NW
Cullman, AZ 35055 - Phone
- (256) 739-4910
- Fax
- (256) 739-9455
- NPI assigned
- Jul 28, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1019709 | AL | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alabama Psychiatric Services PC | Psychiatry | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 1019709 | AL | Yes |
Addresses
Primary practice location
409 Second Ave NW
Cullman, AZ 35055
Mailing address
409 Second Ave NW
Cullman, AZ 35055
Phone (256) 739-4910
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.