Provider Demographics
NPI:1902931108
Name:LIAO, SHIRLEY SHIH-I (PHD)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:SHIH-I
Last Name:LIAO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17632 IRVINE BLVD
Mailing Address - Street 2:250
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3148
Mailing Address - Country:US
Mailing Address - Phone:310-873-7579
Mailing Address - Fax:714-508-7301
Practice Address - Street 1:17632 IRVINE BLVD
Practice Address - Street 2:#250
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3148
Practice Address - Country:US
Practice Address - Phone:714-265-7939
Practice Address - Fax:714-508-7301
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22273103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA09029113250129-002Medicare PIN