Provider Demographics
NPI:1487899233
Name:SHAW, LINDSLEY MARIE
Entity type:Individual
Prefix:
First Name:LINDSLEY
Middle Name:MARIE
Last Name:SHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 TEXAS ST.
Mailing Address - Street 2:SUITE 203 HOME START
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:91208
Mailing Address - Country:US
Mailing Address - Phone:619-692-0727
Mailing Address - Fax:619-692-0785
Practice Address - Street 1:463 N MIDWAY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027
Practice Address - Country:US
Practice Address - Phone:760-489-4957
Practice Address - Fax:740-740-1372
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator