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SHIRAZ TATA PHD LLC
NPI 1083109524
Psychologist - Clinical in Rockford, IL

Active since June 27, 2018
6072 BRYNWOOD DR STE 107, ROCKFORD, IL 61114(815) 519-2949 Get Directions Write a Review

NPPES record last updated: August 1, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Aug 1, 2018, Jun 27, 2018 (2 updates tracked since 2018).

About Shiraz Tata Phd Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHIRAZ TATA PHD LLC (NPI 1083109524), doing business as Shiraz P. Tata, is a healthcare organization registered as a clinical in Rockford, Illinois and active in the NPI registry since June 2018. The organization lists Shiraz P Tata, Licensed Clinical Psychologist, as its authorized official.

NPPES Registry Identity

NPI1083109524
Entity TypeOrganization
Primary Taxonomy103TC0700X
Legal Business NameSHIRAZ TATA PHD LLC
Location Address6072 BRYNWOOD DR STE 107Rockford, IL 61114
Mailing Address6072 Brynwood Dr Ste 107Rockford, IL 61114-5829 · (815) 519-2949
Phone(815) 519-2949
Organization SubpartNo
Authorized OfficialShiraz P TataLicensed Clinical Psychologist · (815) 519-2949
Enumeration DateJune 27, 2018
Last NPPES UpdateAugust 1, 20182 updates tracked since enumeration
✔ NPI 1083109524 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in IL · 071.04963
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
6072 BRYNWOOD DR STE 107, Rockford, IL 61114
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Other Names 1

Former Legal Business NameShiraz P. Tata

Other Identifiers 2

Other11740000Caqh
Other819809569Bcbsil

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

STEPHANIE YATES LCPC
Counselor (Professional)
6072 BRYNWOOD DR STE 107
ROCKFORD, IL 61114
Winnebago County (815) 846-0684
MOSAIC COUNSELING SERVICES, INC
Clinic/Center (Mental Health (Including Community Mental Health Center))
6072 BRYNWOOD DR STE 107
ROCKFORD, IL 61114
Winnebago County (815) 846-0684
SHIRAZ P TATA PH.D.
Psychologist
6072 BRYNWOOD DR STE 107
ROCKFORD, IL 61114
Winnebago County (815) 519-2949

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Shiraz Tata Phd LLC's NPI number?

The NPI number for Shiraz Tata Phd LLC is 1083109524. It was assigned to this organization in the NPPES registry on June 27, 2018. The provider was formerly known as Shiraz P. Tata.

Where is Shiraz Tata Phd LLC located?

Shiraz Tata Phd LLC is located at 6072 Brynwood Dr Ste 107, Rockford, IL 61114. The listed phone number is (815) 519-2949.

What is Shiraz Tata Phd LLC's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

When was this NPI record last updated?

The NPPES record for Shiraz Tata Phd LLC was last updated on August 1, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.