Healthcare Provider Details

I. General information

NPI: 1497149876
Provider Name (Legal Business Name): SAN FRANCISCO NEUROPSYCHOLOGY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 03/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 MARKET ST SUITE 809
SAN FRANCISCO CA
94103-1814
US

IV. Provider business mailing address

833 MARKET ST SUITE 809
SAN FRANCISCO CA
94103-1814
US

V. Phone/Fax

Practice location:
  • Phone: 415-627-9095
  • Fax: 415-627-9108
Mailing address:
  • Phone: 415-627-9095
  • Fax: 415-627-9108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number21904
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number21904
License Number StateCA

VIII. Authorized Official

Name: DR. SHELLEY PEERY
Title or Position: OWNER
Credential: PHD
Phone: 415-218-6915