Healthcare Provider Details

I. General information

NPI: 1740399880
Provider Name (Legal Business Name): AMANDA C SHILS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4965 E LOST BRIDGE RD
DECATUR IL
62521-5139
US

IV. Provider business mailing address

1770 E LAKE SHORE DR
DECATUR IL
62521-3832
US

V. Phone/Fax

Practice location:
  • Phone: 217-864-5531
  • Fax: 217-864-2449
Mailing address:
  • Phone: 217-464-1470
  • Fax: 217-464-5163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085001947
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085001947
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: