Healthcare Provider Details

I. General information

NPI: 1093745531
Provider Name (Legal Business Name): SHAMIK SHAH ACPNP/APN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N CHILDRENS PLZ
CHICAGO IL
60614-3363
US

IV. Provider business mailing address

630 N STATE ST UNIT 1010
CHICAGO IL
60610-7574
US

V. Phone/Fax

Practice location:
  • Phone: 773-975-8839
  • Fax:
Mailing address:
  • Phone: 312-596-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: