Healthcare Provider Details

I. General information

NPI: 1265261168
Provider Name (Legal Business Name): SHREES A BAWANI PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 CALEDONIA CT
PEACHTREE CITY GA
30269-2314
US

IV. Provider business mailing address

341 CALEDONIA CT
PEACHTREE CITY GA
30269-2314
US

V. Phone/Fax

Practice location:
  • Phone: 847-660-4822
  • Fax:
Mailing address:
  • Phone: 847-660-4822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178016089
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: