Healthcare Provider Details

I. General information

NPI: 1831019736
Provider Name (Legal Business Name): KHARA LESLIE SANDIFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KHARA SCOTT

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 E 93RD ST
CHICAGO IL
60617-3909
US

IV. Provider business mailing address

2320 E 93RD ST
CHICAGO IL
60617-3909
US

V. Phone/Fax

Practice location:
  • Phone: 773-967-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number041.427841
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: