Healthcare Provider Details

I. General information

NPI: 1093076853
Provider Name (Legal Business Name): SOPHIANNE DIVYA SCHWAB M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 SHERMAN AVE STE 205A
EVANSTON IL
60201-3753
US

IV. Provider business mailing address

1609 SHERMAN AVE STE 205A
EVANSTON IL
60201-3753
US

V. Phone/Fax

Practice location:
  • Phone: 847-242-1480
  • Fax:
Mailing address:
  • Phone: 847-242-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036.148034
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: