Active NPI
Shannon McKee Dillon
- Psychologist
- Berkeley, CA
National Provider Identifier
1972939866
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 31688
- Practice address
- 2607 Fulton St
Apartment a
Berkeley, CA 94704 - Phone
- (530) 448-2801
- NPI assigned
- Sep 24, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 61055150 | WA | |
| Psychologist | 103T00000X | 31688 | CA | Primary |
Addresses
Primary practice location
2607 Fulton St
Apartment a
Berkeley, CA 94704
Mailing address
2607 Fulton St
Apartment a
Berkeley, CA 94704-3228
Phone (530) 448-2801
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 |
|---|---|---|---|
| 31688 | CA | MD | Psychologist |
| 61055150 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1379980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687996800000",
"number": "1972939866",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2607 FULTON ST",
"address_2": "APARTMENT A",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947043228",
"telephone_number": "530-448-2801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2607 FULTON ST",
"address_2": "APARTMENT A",
"city": "BERKELEY",
"state": "CA",
"postal_code": "94704",
"telephone_number": "530-448-2801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DILLON",
"first_name": "SHANNON",
"middle_name": "MCKEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-09-24",
"last_updated": "2023-06-29",
"certification_date": "2023-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "61055150",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "31688",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.