Healthcare Provider Details

I. General information

NPI: 1790736627
Provider Name (Legal Business Name): SHERALEE PRADEEP SHAH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 84TH DR STE D
MERRILLVILLE IN
46410-8606
US

IV. Provider business mailing address

445 EAST OHIO APT 3914
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 219-736-7646
  • Fax: 219-736-7643
Mailing address:
  • Phone: 248-703-6613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: