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1336298504
SHIRAZ P TATA
ROCKFORD, IL
NPI
1336298504
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
103T00000X Psychologist
(Licence: IL 071-004963)
Enumeration Date
2007-01-09
Last Update Date
2018-06-18
Business Address
SHIRAZ P TATA PH.D.
6072 BRYNWOOD DR STE 107
ROCKFORD, IL 61114
Phone number: 815-519-2949
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Mailing Address
SHIRAZ P TATA PH.D.
6072 BRYNWOOD DR STE 107
ROCKFORD, IL 61114-5829
Phone number: 815-519-2949
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