Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shiraz P Tata, PHD

Individual provider Psychologist · NPI 1336298504

Shiraz P Tata, PHD is a Clinical Psychologist in Rockford, Illinois. Graduated from Southern Illinois University School of Medicine in 1993, 33 years ago. Accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
33
Trained at
Southern Illinois University School of Medicine
Licensed in
IL
In the registry since
2007
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

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Practice location Address checks out

6072 Brynwood Dr Ste 107
Rockford, IL 61114
Phone: (815) 519-2949
Fax: (815) 637-4483
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychologist (primary) Taxonomy 103T00000X · Licence 071-004963 (IL)

Record details

NPI number1336298504
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHD
Sole proprietorNo
NPI enumeratedJanuary 9, 2007
Last updated in NPPESJune 18, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolSOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
Graduated 1993 (33 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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