Active NPI
Ambreen Shahabuddin, PHD
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1245526573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3159
- Practice address
- 707 SW Gaines St
Portland, OR 97239 - Phone
- (503) 494-2155
- NPI assigned
- Jun 24, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3159 | OR | Primary |
Addresses
Primary practice location
707 SW Gaines St
Portland, OR 97239
Mailing address
3720 SW Bond Ave Unit 710
Portland, OR 97239-4573
Phone (775) 815-6691
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3159 | OR | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571184000000",
"number": "1245526573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3720 SW BOND AVE UNIT 710",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972394573",
"telephone_number": "775-815-6691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 SW GAINES ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97239",
"telephone_number": "503-494-2155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAHABUDDIN",
"first_name": "AMBREEN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-24",
"last_updated": "2019-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "3159",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.