Healthcare Provider Details

I. General information

NPI: 1497689640
Provider Name (Legal Business Name): ROXXY SHYANNA TAFOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

778 W FRONTAGE RD STE 101
NORTHFIELD IL
60093-1209
US

IV. Provider business mailing address

838 PRESCOTT ST UNIT 2
WAUKEGAN IL
60085-7416
US

V. Phone/Fax

Practice location:
  • Phone: 312-780-0820
  • Fax: 877-716-4799
Mailing address:
  • Phone: 312-780-0820
  • Fax: 877-716-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: