Healthcare Provider Details

I. General information

NPI: 1326972217
Provider Name (Legal Business Name): JACKLEEN G SHUMEIL PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 N WESTERN AVE UNIT A
CHICAGO IL
60622-2416
US

IV. Provider business mailing address

1509 N WESTERN AVE UNIT A
CHICAGO IL
60622-2416
US

V. Phone/Fax

Practice location:
  • Phone: 773-227-3303
  • Fax: 773-897-5848
Mailing address:
  • Phone: 773-227-3303
  • Fax: 773-897-5848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209035525
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: