Healthcare Provider Details

I. General information

NPI: 1477242329
Provider Name (Legal Business Name): SHAMARA BATTLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

152 W LINCOLN HWY
CHICAGO HEIGHTS IL
60411-2619
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-8805
  • Fax:
Mailing address:
  • Phone: 708-754-9687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.179977
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberCLP05900
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberCLP05900
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: