Healthcare Provider Details

I. General information

NPI: 1043978190
Provider Name (Legal Business Name): MISS SHUNIAYA GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 OLD ORCHARD RD STE 300
SKOKIE IL
60077-4462
US

IV. Provider business mailing address

5250 OLD ORCHARD RD STE 300
SKOKIE IL
60077-4462
US

V. Phone/Fax

Practice location:
  • Phone: 224-444-9934
  • Fax:
Mailing address:
  • Phone: 224-444-9934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: