DR. CHRISSYL KANDIS SHAW (PSY.D.) – Psychologist, NPI 1609217280

DR. CHRISSYL KANDIS SHAW (PSY.D.) is a healthcare provider. based in Plantation, Florida. specializing in CLINICAL PSYCHOLOGIST. They hold the professional credentials PSY.D.. They hold a License No. PY8765 (FL). The NPI Number for DR. CHRISSYL KANDIS SHAW (PSY.D.) is 1609217280

Main info

Female
Sole Proprietor
16 Years Of Experience
Accepts Medicare Assignment
Name
DR. CHRISSYL KANDIS SHAW (PSY.D.)
NPI
1609217280
Phone
(954) 583-4568
Address
4121 NW 5TH ST
Enumeration Date
11 July 2013
Last Update Date
1 December 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3525657342
Graduation Year
2010 (16 years ago)
PAC ID
3870819428
Group Practice PAC ID
0648664698
Professional Enrollment ID
I20150226000794
Address ID
FL344283422CR927XXAVEX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience53
Completeness75
Years active:12State licenses:1Digital endpointsOther names

1,602 CLINICAL PSYCHOLOGIST in FL

Provider Addresses for DR. CHRISSYL KANDIS SHAW (PSY.D.)

  • 4121 NW 5TH ST

    SUITE 207

    PLANTATION, FL 333172120

    Phone: (954) 583-4568

    Fax: (954) 583-4528

    Type: Mailing

  • 725 N 12th Ave Bldg B

    Arcadia, FL 342668752

    Phone: (863) 494-1242

    Fax: (863) 993-0108

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2015-02-26

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20150226000794IClinical PsychologistFLTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 33317)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0648664698View full group profile
NameSpecialtyState
Nurse PractitionerFL
Nurse PractitionerFL
Nurse PractitionerFL
Nurse PractitionerFL

Reviews

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Frequently asked questions

Can I cross-check DR. CHRISSYL KANDIS SHAW (PSY.D.) using NPI 1609217280?
NPI 1609217280 belongs to DR. CHRISSYL KANDIS SHAW (PSY.D.); compare other details if you need extra assurance.
Is DR. CHRISSYL KANDIS SHAW (PSY.D.) still an active registrant?
DR. CHRISSYL KANDIS SHAW (PSY.D.) carries an active NPI according to the public dataset.
What area of care is associated with DR. CHRISSYL KANDIS SHAW (PSY.D.)?
DR. CHRISSYL KANDIS SHAW (PSY.D.)'s record emphasizes Psychologist. Clinical services aligned with this taxonomy classification.
Is DR. CHRISSYL KANDIS SHAW (PSY.D.) located near Plantation?
DR. CHRISSYL KANDIS SHAW (PSY.D.) currently maps to Plantation, Florida in this extract.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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