Active NPI
Vijay Shankar, PSY.D.
- Psychologist
- Portland, OR
National Provider Identifier
1457534976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1281
- Practice address
- 10490SW Eastridge Street
Suite 110-D
Portland, OR 97225 - Phone
- (503) 297-2257
- Fax
- (503) 297-1787
- NPI assigned
- Dec 6, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1281 | OR | Primary |
Addresses
Primary practice location
10490SW Eastridge Street
Suite 110-D
Portland, OR 97225
Mailing address
10490SW Eastridge Street
Suite 110-D
Portland, OR 97225
Phone (503) 297-2257
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 20, 2020 through Jul 20, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1281 | OR | MD | Naturopath |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196899200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196899200000",
"number": "1457534976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10490SW EASTRIDGE STREET",
"address_2": "SUITE 110-D",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97225",
"telephone_number": "503-297-2257",
"fax_number": "503-297-1787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10490SW EASTRIDGE STREET",
"address_2": "SUITE 110-D",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97225",
"telephone_number": "503-297-2257",
"fax_number": "503-297-1787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANKAR",
"first_name": "VIJAY",
"name_prefix": "Mr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-06",
"last_updated": "2007-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OR",
"license": "1281",
"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 Dec 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.