Provider Demographics
NPI:1063912350
Name:SHANNON, ROBYN PAPATHAKIS (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:PAPATHAKIS
Last Name:SHANNON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ROBYN
Other - Middle Name:ELISE
Other - Last Name:PAPATHAKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5239 CLAREMONT AVE APT 26
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1035 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2275
Practice Address - Country:US
Practice Address - Phone:415-237-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29767103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical