Active NPI
Ryan Fredrick Shallat, PSY.D.
- Clinical Psychologist
- Oakland, CA
National Provider Identifier
1528117082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- RPS 2006052
- Practice address
- 4368 Lincoln Ave
Oakland, CA 94602-2529 - Phone
- (510) 482-6632
- NPI assigned
- Jan 10, 2007
- Sex
- Male
- 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 | RPS 2006052 | CA | Primary |
Addresses
Primary practice location
4368 Lincoln Ave
Oakland, CA 94602-2529
Mailing address
846 Alma PL
Oakland, CA 94610-2502
Phone (510) 508-3707
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPS 2006052 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168387200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1528117082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "846 ALMA PL",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946102502",
"telephone_number": "510-508-3707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4368 LINCOLN AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946022529",
"telephone_number": "510-482-6632"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHALLAT",
"first_name": "RYAN",
"middle_name": "FREDRICK",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "RPS 2006052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.