Healthcare Provider Details

I. General information

NPI: 1376457218
Provider Name (Legal Business Name): JAMIE SHISH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 S BRYAN ST
ELMHURST IL
60126-4343
US

IV. Provider business mailing address

716 S BRYAN ST
ELMHURST IL
60126-4343
US

V. Phone/Fax

Practice location:
  • Phone: 630-390-0866
  • Fax:
Mailing address:
  • Phone: 630-390-0866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: