Individual
SHIRAZ P TATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
6072 BRYNWOOD DR STE 107, ROCKFORD, IL 61114
(815) 519-2949
(815) 637-4483
Mailing address
6072 BRYNWOOD DR STE 107, ROCKFORD, IL 61114-5829
(815) 519-2949
(815) 637-4483
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
071-004963
IL
Other
Enumeration date
01/09/2007
Last updated
06/18/2018
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