Healthcare Provider Details

I. General information

NPI: 1629995428
Provider Name (Legal Business Name): NANDINI VAISHNAV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE
MAYWOOD IL
60153-3328
US

IV. Provider business mailing address

130 BARRINGTON PKWY
STOCKBRIDGE GA
30281-4770
US

V. Phone/Fax

Practice location:
  • Phone: 773-274-3000
  • Fax:
Mailing address:
  • Phone: 443-915-1589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: