Healthcare Provider Details

I. General information

NPI: 1841028917
Provider Name (Legal Business Name): TWISHA MAYUR SHAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 S MICHIGAN AVE STE 900
CHICAGO IL
60604-4393
US

IV. Provider business mailing address

5811 LANDCASTER CIR
MCHENRY IL
60050-5987
US

V. Phone/Fax

Practice location:
  • Phone: 813-395-1073
  • Fax:
Mailing address:
  • Phone: 630-492-6760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: