Provider Demographics
NPI:1063627156
Name:SHIRGUL, ELLEN DAYTON (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:DAYTON
Last Name:SHIRGUL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:MARIE
Other - Last Name:DAYTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2425 BISSO LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-4897
Mailing Address - Country:US
Mailing Address - Phone:925-521-5650
Mailing Address - Fax:925-521-5639
Practice Address - Street 1:2425 BISSO LN
Practice Address - Street 2:SUITE 100
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4897
Practice Address - Country:US
Practice Address - Phone:925-521-5650
Practice Address - Fax:925-521-5639
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 23749103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical