Healthcare Provider Details

I. General information

NPI: 1649407065
Provider Name (Legal Business Name): NANCY ZOMAYA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NANCY ZOMAYA SHUNNESON DPM

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 W TOUHY AVE
CHICAGO IL
60646
US

IV. Provider business mailing address

917 CRESTFIELD AVE
LIBERTYVILLE IL
60048-3019
US

V. Phone/Fax

Practice location:
  • Phone: 847-673-5166
  • Fax:
Mailing address:
  • Phone: 847-912-6141
  • Fax: 224-513-4394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016.005444
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: