Shiraz Tata PHD LLC

NPI #1083109524 in Rockford, Illinois

Provider Information

NPI Number: 1083109524
Entity Type: Organization
Organization Name: Shiraz Tata PHD LLC
Primary Specialty: Psychologist - Clinical
Enumeration Date: Jun 27, 2018
Last Updated: Aug 1, 2018

Practice Location

Address: 6072 BRYNWOOD DR STE 107
City: Rockford
State: Illinois
ZIP Code: 61114
Phone: (815) 519-2949

Authorized Official

Name: SHIRAZ P TATA, PH D
Title: LICENSED CLINICAL PSYCHOLOGIST
Phone: (815) 519-2949

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Clinical — Clinical	103TC0700X	Primary

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