Healthcare Provider Details

I. General information

NPI: 1558431510
Provider Name (Legal Business Name): SHARON PRYSTALSKI PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 W HAWTHORN PKWY SUITE 260
VERNON HILLS IL
60061-1446
US

IV. Provider business mailing address

1701 E. WOODFIELD ROAD SUITE 1000
SCHAUMBURG IL
60173-5113
US

V. Phone/Fax

Practice location:
  • Phone: 847-918-8282
  • Fax: 847-240-2418
Mailing address:
  • Phone: 847-918-8282
  • Fax: 847-240-2418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: