Basic Information
| Provider Information | |||||||||
| NPI: | 1356450340 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SHAWBERRY | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 PINE VALLEY DR | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434025202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192763801 | ||||||||
| FaxNumber: | 4194237854 | ||||||||
| Practice Location | |||||||||
| Address1: | 970 W WOOSTER ST | ||||||||
| Address2: | SUITE 124, PSYCHOLOGICAL RESOURCES | ||||||||
| City: | BOWLING GREEN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434022643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193526666 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 35-079917 | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.