{"npi":"1083109524","type":"NPI-2","status":"active","name":{"display":"Shiraz Tata PHD LLC","other":[],"organization_name":"SHIRAZ TATA PHD LLC","authorised_official":"Shiraz Tata"},"specialty":{"primary_taxonomy":"103TC0700X","primary_taxonomy_description":"Clinical Psychologist","slug":"clinical-psychologist","schema_org_specialty":null,"all":[{"code":"103TC0700X","description":"Clinical Psychologist","primary":true,"state":"IL","license":"071.04963"}]},"addresses":[{"purpose":"LOCATION","street_1":"6072 BRYNWOOD DR STE 107","city":"ROCKFORD","state":"IL","postal_code":"61114","country_code":"US","phone":"8155192949"},{"purpose":"MAILING","street_1":"6072 BRYNWOOD DR STE 107","city":"ROCKFORD","state":"IL","postal_code":"611145829","country_code":"US","phone":"8155192949"}],"license":{"state":"IL","number":"071.04963"},"identifiers":[{"type_code":"01","label":"Other","value":"819809569","state":null,"issuer":"BCBSIL"},{"type_code":"01","label":"Other","value":"11740000","state":null,"issuer":"CAQH"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20190103003194","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"IL","pac_id":"2668718198"}]},"enumeration_date":"2018-06-27","last_updated":"2018-08-01","_meta":{"source":"NPPES","snapshot_date":"2018-08-01","doc_url":"https://findmynpi.com/api"}}