Shiraz Tata PHD LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.04963 Issued in IL

Legal business name

SHIRAZ TATA PHD LLC

Practice address

6072 Brynwood Dr Ste 107
Rockford, IL 61114

Phone

(815) 519-2949

NPI assigned

Jun 27, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shiraz P Tata, PH DNPI 1336298504

Title

Licensed Clinical Psychologist

Phone

(815) 519-2949

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Shiraz P. Tata Former legal business name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shiraz P Tata, PH.D.

  • Psychologist
  • Rockford, IL
  • NPI 1336298504
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1530057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533081600000",
    "number": "1083109524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6072 BRYNWOOD DR STE 107",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611145829",
            "telephone_number": "815-519-2949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6072 BRYNWOOD DR STE 107",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "61114",
            "telephone_number": "815-519-2949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHIRAZ TATA PHD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-27",
        "last_updated": "2018-08-01",
        "status": "A",
        "authorized_official_last_name": "TATA",
        "authorized_official_first_name": "SHIRAZ",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "LICENSED CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "815-519-2949",
        "authorized_official_credential": "PH D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.04963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSIL",
            "identifier": "819809569",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11740000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shiraz P. Tata",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Mark T Shiels, M.D.
• Peggy Shiels, MD
• Evan Hocheul Shin, DDS
• Sharon Shipp
• Liza A Dafchahi Shirani, MD
• Norman E Shirk Jr., LCPC
• David S Shoberg, M.D.
• William G Shold, DDS
• Margaret Ruth Shook, COTA/L
• Shoptikal LLC

• Clinical Psychologist in Rockford, IL
• Providers in Rockford, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.