Healthcare Provider Details

I. General information

NPI: 1477973675
Provider Name (Legal Business Name): RAFAT SHONEYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2014
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 E 47TH ST
CHICAGO IL
60653-4224
US

IV. Provider business mailing address

654 E 47TH ST
CHICAGO IL
60653-4224
US

V. Phone/Fax

Practice location:
  • Phone: 773-624-4800
  • Fax:
Mailing address:
  • Phone: 773-624-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.387944
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.011484
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: