Provider Demographics
NPI:1972350718
Name:SHAW, SHATONYA (PHD)
Entity type:Individual
Prefix:DR
First Name:SHATONYA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHATONYA
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:644 BRIXHAM RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-1165
Mailing Address - Country:US
Mailing Address - Phone:614-795-9655
Mailing Address - Fax:
Practice Address - Street 1:4301 CLIME RD N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-3403
Practice Address - Country:US
Practice Address - Phone:614-276-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YP2500X, 104100000X, 103TC1900X, 104100000X, 106H00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist