Healthcare Provider Details

I. General information

NPI: 1154895852
Provider Name (Legal Business Name): SHAIMAA RAHEEM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 GIVEN DR
FLORA IL
62839-1094
US

IV. Provider business mailing address

1411 S SMITH RD
URBANA IL
61802-4751
US

V. Phone/Fax

Practice location:
  • Phone: 618-662-8381
  • Fax:
Mailing address:
  • Phone: 202-560-4182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242004746
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: