Active NPI
Sharon Stafanson, PSY.D.
- Psychologist
- Oakland, CA
National Provider Identifier
1669639936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY 21600
- Practice address
- 5435 College Ave
Suite 202-6
Oakland, CA 94618-1598 - Phone
- (510) 219-3029
- NPI assigned
- May 22, 2008
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY 21600 | CA | Primary |
Addresses
Primary practice location
5435 College Ave
Suite 202-6
Oakland, CA 94618-1598
Mailing address
154 Ricardo Ave
Piedmont, CA 94611-3938
Phone (510) 219-3029
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 19, 2025 through Feb 19, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21600 | CA | MD | Professional Counselor |
| PSY 21600 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211414400000",
"number": "1669639936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "154 RICARDO AVE",
"city": "PIEDMONT",
"state": "CA",
"postal_code": "946113938",
"telephone_number": "510-219-3029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5435 COLLEGE AVE",
"address_2": "SUITE 202-6",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946181598",
"telephone_number": "510-219-3029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAFANSON",
"first_name": "SHARON",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-22",
"last_updated": "2008-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 21600",
"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 May 22, 2008; 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.