Healthcare Provider Details

I. General information

NPI: 1558548602
Provider Name (Legal Business Name): DR. SHANNON M. ULRIKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PHELAN AVE
SAN FRANCISCO CA
94112-1821
US

IV. Provider business mailing address

PO BOX 1431
MENLO PARK CA
94026-1431
US

V. Phone/Fax

Practice location:
  • Phone: 415-452-5384
  • Fax:
Mailing address:
  • Phone: 510-265-4585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY21225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: