1407880990 NPI number — SHANNON ELISE MCCASLIN-RODRIGO PH.D.

Table of content: SHANNON ELISE MCCASLIN-RODRIGO PH.D. (NPI 1407880990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407880990 NPI number — SHANNON ELISE MCCASLIN-RODRIGO PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCASLIN-RODRIGO
Provider First Name:
SHANNON
Provider Middle Name:
ELISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCASLIN
Provider Other First Name:
SHANNON
Provider Other Middle Name:
ELISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407880990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SF VA MEDICAL CENTER, 4150 CLEMENT ST. (116P)
Provider Second Line Business Mailing Address:
PTSD RESEARCH PROGRAM, BLDG 8, ROOM 320
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-221-4810
Provider Business Mailing Address Fax Number:
415-751-2297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4150 CLEMENT ST
Provider Second Line Business Practice Location Address:
SFVAMC, PTSD RESEARCH PROGRAM (116P), BLDG 8, ROOM 320
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94121-1545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-221-4810
Provider Business Practice Location Address Fax Number:
415-751-2297
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  20578 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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