Provider Demographics
NPI:1457534976
Name:SHANKAR, VIJAY (PSYD)
Entity Type:Individual
Prefix:MR
First Name:VIJAY
Middle Name:
Last Name:SHANKAR
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10490SW EASTRIDGE STREET
Mailing Address - Street 2:SUITE 110-D
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225
Mailing Address - Country:US
Mailing Address - Phone:503-297-2257
Mailing Address - Fax:503-297-1787
Practice Address - Street 1:10490SW EASTRIDGE STREET
Practice Address - Street 2:SUITE 110-D
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:503-297-2257
Practice Address - Fax:503-297-1787
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1281103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist