Jessica London L. S. Huffine Shaddock, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY20149 Issued in CA

Practice address

842 California St
San Francisco, CA 94108-2315

Phone

(510) 717-6761

NPI assigned

Sep 16, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295827200000",
    "number": "1700982576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2704 MATHEWS ST",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947022216",
            "telephone_number": "510-717-6761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "842 CALIFORNIA ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941082315",
            "telephone_number": "510-717-6761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHADDOCK",
        "first_name": "JESSICA",
        "middle_name": "LONDON L. S. HUFFINE",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-16",
        "last_updated": "2011-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY20149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zubedah Calderon Shabazz
• Olivia Shabb, B.A.
• Erica Latoya Shackelford
• Todd Christian Shackelford
• Catherine Lynn Shaddix, M.A.
• Elham Shadmehr, DDS, MS
• Daniel Albert Shadoan, D.O.
• Kathleen Shadoan
• Carly Shadron
• Mahnour Shadzi, AMFT

• Clinical Psychologist in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.