Healthcare Provider Details

I. General information

NPI: 1700602836
Provider Name (Legal Business Name): SHILPY SARGURU DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELBY SARGURU DNP

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 W SUNNYSIDE AVE STE 201
CHICAGO IL
60640-5684
US

IV. Provider business mailing address

3215 N TROY ST APT 1
CHICAGO IL
60618-5796
US

V. Phone/Fax

Practice location:
  • Phone: 773-935-6126
  • Fax:
Mailing address:
  • Phone: 847-828-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209031133
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041445443
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: