Healthcare Provider Details

I. General information

NPI: 1619198454
Provider Name (Legal Business Name): ALAN D. SHONKOFF PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 WARD ST SUITE 102
BERKELEY CA
94705-1124
US

IV. Provider business mailing address

2340 WARD ST SUITE 102
BERKELEY CA
94705-1124
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-0402
  • Fax:
Mailing address:
  • Phone: 510-848-0402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY 7303
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: