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

Q: 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.

Q: What is Shiraz Tata Phd LLC's specialty?

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

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: October 25, 2026.

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

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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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Shiraz Tata Phd Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Shiraz Tata Phd LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Shiraz Tata, PH.D.

Clinical Psychologist

NPI 1336298504

6072 BRYNWOOD DR STE 107
Rockford, IL 61114

(815) 519-2949

✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

Is Shiraz Tata Phd LLC enrolled in Medicare?

Yes. Shiraz Tata Phd LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Shiraz Tata Phd LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Psychologist) reassigns their Medicare billing to Shiraz Tata Phd LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.