Healthcare Provider Details

I. General information

NPI: 1518802651
Provider Name (Legal Business Name): SHAMYIAH GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6930 ROOSEVELT RD
OAK PARK IL
60304-1845
US

IV. Provider business mailing address

913 S MONITOR AVE
CHICAGO IL
60644-5430
US

V. Phone/Fax

Practice location:
  • Phone: 708-358-3000
  • Fax:
Mailing address:
  • Phone: 224-349-3707
  • Fax:

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: