Provider Demographics
NPI:1033561501
Name:SHAW, DOMONIQUE CASPER (PHD)
Entity type:Individual
Prefix:DR
First Name:DOMONIQUE
Middle Name:CASPER
Last Name:SHAW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DOMONIQUE
Other - Middle Name:RENEE
Other - Last Name:CASPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:580 COLUMBIA AVE
Mailing Address - Street 2:APT 5
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-4481
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3401 BEECH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95652
Practice Address - Country:US
Practice Address - Phone:169-640-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist