Healthcare Provider Details

I. General information

NPI: 1548764301
Provider Name (Legal Business Name): SHAYNA FRIEDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 ROOSEVELT RD
BERWYN IL
60402-1108
US

IV. Provider business mailing address

6201 ROOSEVELT RD
BERWYN IL
60402-1108
US

V. Phone/Fax

Practice location:
  • Phone: 708-386-0845
  • Fax: 708-386-8472
Mailing address:
  • Phone: 708-386-0845
  • Fax: 708-386-8472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036156324
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: