Healthcare Provider Details

I. General information

NPI: 1255269494
Provider Name (Legal Business Name): SHUNDRA YUVETTE ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3416 S HALSTED ST
CHICAGO IL
60608-6708
US

IV. Provider business mailing address

1916 W 163RD ST
MARKHAM IL
60428-5623
US

V. Phone/Fax

Practice location:
  • Phone: 773-823-9434
  • Fax:
Mailing address:
  • Phone: 773-418-2947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209035341
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: