Active NPI
Timothy S Shaw, PHD
- Counseling Psychologist
- New Smyrna Beach, FL
National Provider Identifier
1811959331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- PY2148
- Practice address
- 136 Julia St Unit 100
New Smyrna Beach, FL 32168-7713 - Phone
- (386) 423-9161
- Fax
- (386) 423-3094
- NPI assigned
- Apr 3, 2006
- 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 |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | PY2148 | FL | Primary |
Addresses
Primary practice location
136 Julia St Unit 100
New Smyrna Beach, FL 32168-7713
Mailing address
136 Julia St Unit 100
New Smyrna Beach, FL 32168-7713
Phone (386) 423-9161
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY2148 | FL | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144022400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593561600000",
"number": "1811959331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "136 JULIA ST UNIT 100",
"city": "NEW SMYRNA BEACH",
"state": "FL",
"postal_code": "321687713",
"telephone_number": "386-423-9161",
"fax_number": "386-423-3094"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "136 JULIA ST UNIT 100",
"city": "NEW SMYRNA BEACH",
"state": "FL",
"postal_code": "321687713",
"telephone_number": "386-423-9161",
"fax_number": "386-423-3094"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "TIMOTHY",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-04-03",
"last_updated": "2020-07-01",
"certification_date": "2020-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "FL",
"license": "PY2148",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Smyrna Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.