Healthcare Provider Details

I. General information

NPI: 1306757539
Provider Name (Legal Business Name): SHENOY PSYCHIATRY CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N MICHIGAN AVE STE 704
CHICAGO IL
60602-3817
US

IV. Provider business mailing address

30 N MICHIGAN AVE STE 704
CHICAGO IL
60602-3817
US

V. Phone/Fax

Practice location:
  • Phone: 312-620-2024
  • Fax:
Mailing address:
  • Phone: 312-620-2024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUDHAKAR SHENOY
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 312-620-2024