Provider Demographics
NPI:1770728115
Name:SHAW, MELAUREE ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:MELAUREE
Middle Name:ANN
Last Name:SHAW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6507
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95763-6507
Mailing Address - Country:US
Mailing Address - Phone:360-789-2412
Mailing Address - Fax:818-914-4663
Practice Address - Street 1:101 PARKSHORE DR
Practice Address - Street 2:STE 132
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-4726
Practice Address - Country:US
Practice Address - Phone:360-789-2412
Practice Address - Fax:818-914-4663
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103T00000X
CA27575103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist