MEDICARE: MS. SHISHA P AMABEL M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		IL

General Provider Information

NPI Number	:	1811970213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHISHA P AMABEL M.S.

Provider Business Mailing Address
First Line	:	1907 W CORNELIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1041
Country	:	US
Telephone Number	:	773-935-8263
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 W BELMONT AVE
Second Line	:	SUITE 212
City	:	CHICAGO
State	:	IL
Zip	:	60657-3200
Country	:	US
Telephone Number	:	773-248-0949
Fax Number	:	312-337-7232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	07/08/2007

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