Active NPI
Shannon Mariko Huddleston, PSYD
- Clinical Psychologist
- Alameda, CA
National Provider Identifier
1518307164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY29981
- Practice address
- 2325 Clement Ave
Alameda, CA 94501-7063 - Phone
- (510) 629-6300
- Fax
- (510) 865-1930
- NPI assigned
- Jun 27, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 | PSY29981 | CA | Primary |
Addresses
Primary practice location
2325 Clement Ave
Alameda, CA 94501-7063
Mailing address
2325 Clement Ave
Alameda, CA 94501-7063
Phone (510) 629-6300
Other practice location 1
1516 Oak St Ste 313
Alameda, CA 94501-2958
Phone (510) 946-7986
Other practice location 2
2961 Summit St Ste C6
Oakland, CA 94609-3482
Phone (510) 982-1000 ext. 706
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8121 | Medicaid | CA |
Other names 1
- Dr. Shannon Mariko Pratt
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY29981 | CA | MD | Clinical Psychologist |
| 29981 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579219200000",
"number": "1518307164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2325 CLEMENT AVE",
"city": "ALAMEDA",
"state": "CA",
"postal_code": "945017063",
"telephone_number": "510-629-6300",
"fax_number": "510-865-1930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2325 CLEMENT AVE",
"city": "ALAMEDA",
"state": "CA",
"postal_code": "945017063",
"telephone_number": "510-629-6300",
"fax_number": "510-865-1930"
}
],
"practiceLocations": [
{
"address_1": "1516 Oak St Ste 313",
"address_purpose": "LOCATION",
"city": "Alameda",
"state": "CA",
"postal_code": "945012958",
"country_code": "US",
"telephone_number": "510-946-7986",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2961 Summit St Ste C6",
"address_purpose": "LOCATION",
"city": "Oakland",
"state": "CA",
"postal_code": "946093482",
"country_code": "US",
"telephone_number": "510-982-1000 x706",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HUDDLESTON",
"first_name": "SHANNON",
"middle_name": "MARIKO",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-06-27",
"last_updated": "2020-01-17",
"certification_date": "2020-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY29981",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8121",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SHANNON",
"last_name": "PRATT",
"middle_name": "MARIKO",
"prefix": "DR.",
"credential": "PSYD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Alameda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.