Healthcare Provider Details

I. General information

NPI: 1346067170
Provider Name (Legal Business Name): SHELBY HUGHES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7343 LAKE ST
RIVER FOREST IL
60305-2206
US

IV. Provider business mailing address

1 BLOOMINGDALE PL APT 617
BLOOMINGDALE IL
60108-1294
US

V. Phone/Fax

Practice location:
  • Phone: 708-231-8908
  • Fax:
Mailing address:
  • Phone: 847-714-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209030493
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: