Healthcare Provider Details

I. General information

NPI: 1942138557
Provider Name (Legal Business Name): LASHON SHORTY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5070 W ADAMS ST
CHICAGO IL
60644-4342
US

IV. Provider business mailing address

5070 W ADAMS ST
CHICAGO IL
60644-4342
US

V. Phone/Fax

Practice location:
  • Phone: 773-559-9014
  • Fax: 773-559-9014
Mailing address:
  • Phone: 773-559-9014
  • Fax: 773-559-9014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.034961
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: