Healthcare Provider Details

I. General information

NPI: 1962866202
Provider Name (Legal Business Name): AYESHA SHAUKAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 FOXFIELD RD STE 200
ST CHARLES IL
60174-5799
US

IV. Provider business mailing address

2900 FOXFIELD RD STE 200
ST CHARLES IL
60174-5799
US

V. Phone/Fax

Practice location:
  • Phone: 630-797-4255
  • Fax: 630-797-4259
Mailing address:
  • Phone: 630-797-4255
  • Fax: 630-797-4259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036162532
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: