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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

DR. SHASHONK ILLAM PSY.D.
NPI 1104432228
Clinical Neuropsychologist in San Diego, CA

Active since September 23, 2020
3990 OLD TOWN AVE STE C303, SAN DIEGO, CA 92110(858) 964-0722 Get Directions Write a Review

NPPES record last updated: September 2, 2026. Verified against the NPPES registry weekly; last sync: September 20, 2026.

Record update history: Sep 2, 2026, Jul 5, 2024, Sep 23, 2020 (3 updates tracked since 2020).

About Dr. Shashonk Illam Psy.d. NPPES

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

DR. SHASHONK ILLAM PSY.D. (NPI 1104432228) is an individual clinical neuropsychologist in San Diego, California, licensed in California (36902) and active in the NPI registry since September 2020.

NPPES Registry Identity

NPI1104432228
Entity TypeIndividualMale
Primary Taxonomy103G00000X
Provider Legal NameDR. SHASHONK ILLAMCredential: PSY.D.
Location Address3990 OLD TOWN AVE STE C303San Diego, CA 92110-2932
Mailing Address3990 Old Town Ave Ste C303San Diego, CA 92110-2932 · (858) 964-0722
Phone(858) 964-0722
Sole ProprietorNo
Enumeration DateSeptember 23, 2020
Last NPPES UpdateSeptember 2, 20263 updates tracked since enumeration
NPPES CertifiedSeptember 2, 2026
✔ NPI 1104432228 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinical NeuropsychologistBehavioral Health & Social Service Providers
Taxonomy Code103G00000X
License✔ Licensed in CA · 36902
Definition
A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems.
3990 OLD TOWN AVE STE C303, San Diego, CA 92110
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Other Providers at the Same Location NPPES 5

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

DR. NATALIE ELVITA KURNIADI PHD
Clinical Neuropsychologist
3990 OLD TOWN AVE STE C303
SAN DIEGO, CA 92110
San Diego County (858) 964-0722
DR. SARAH M. JURICK LEFLER PHD
Clinical Neuropsychologist
3990 OLD TOWN AVE STE C303
SAN DIEGO, CA 92110
San Diego County (858) 964-0722
DR. STACY ANN C. AQUIPEL PSY.D
Psychologist (Clinical)
3990 OLD TOWN AVE STE C303
SAN DIEGO, CA 92110
San Diego County (858) 964-0722
ALEXIS OLSON BACHIEGA PHD
Clinical Neuropsychologist
3990 OLD TOWN AVE STE C303
SAN DIEGO, CA 92110
San Diego County (858) 964-0722
PACIFIC NEUROBEHAVIORAL CLINIC: A PSYCHOLOGICAL CORPORATION
Community/Behavioral Health
3990 OLD TOWN AVE STE C303
SAN DIEGO, CA 92110
San Diego County (858) 964-0722

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 Shashonk Illam's NPI number?

The NPI number for Shashonk Illam is 1104432228. It was assigned to this individual provider in the NPPES registry on September 23, 2020.

Where is Shashonk Illam located?

Shashonk Illam practices at 3990 Old Town Ave Ste C303, San Diego, CA 92110. The listed phone number is (858) 964-0722.

What is Shashonk Illam's specialty?

The primary specialty registered for this NPI is Clinical Neuropsychologist with taxonomy code 103G00000X.

When was this NPI record last updated?

The NPPES record for Shashonk Illam was last updated on September 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 days 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.