Provider Demographics
NPI:1346044229
Name:SHAW, KYLIE BRIANNE
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:BRIANNE
Last Name:SHAW
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31256 BELL MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8202
Mailing Address - Country:US
Mailing Address - Phone:951-415-4262
Mailing Address - Fax:
Practice Address - Street 1:27555 YNEZ RD STE 300
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4678
Practice Address - Country:US
Practice Address - Phone:951-694-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician