Healthcare Provider Details

I. General information

NPI: 1508686072
Provider Name (Legal Business Name): SHIVANI DAVE APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHIVANI PANDYA APRN, CNP

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E SUPERIOR ST STE 4-420
CHICAGO IL
60611-2914
US

IV. Provider business mailing address

250 E SUPERIOR ST STE 4-420
CHICAGO IL
60611-2914
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0990
  • Fax: 312-472-4784
Mailing address:
  • Phone: 312-695-0990
  • Fax: 312-472-4784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209030479
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209030479
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209030479
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: