Healthcare Provider Details

I. General information

NPI: 1174315063
Provider Name (Legal Business Name): WINCY FAITH MEJIAS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1S376 SUMMIT AVE STE 5B
OAKBROOK TERRACE IL
60181-3968
US

IV. Provider business mailing address

1S376 SUMMIT AVE STE 5B
OAKBROOK TERRACE IL
60181-3968
US

V. Phone/Fax

Practice location:
  • Phone: 224-300-4268
  • Fax:
Mailing address:
  • Phone: 224-300-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number085011257
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085011257
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: