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General NPI Number Information
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NPI Number | 1114928884
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Entity Type | Individual
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Provider Name | CHANDRIKA SHAH PA
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Gender | Female
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Dates
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Enumeration Date | 08/03/2005
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 500 E 51ST STREET PROVIDENT HOSPITAL OF COOK COUNTY DEPT OF GEN SURGERY
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City | CHICAGO
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State | IL
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Zip | 60615
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Country | US
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Telephone | 312-572-2664
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Fax | 312-572-2681
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Provider Business Mailing Address
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Address Line | 500 E 51ST ST PROVIDENT HOSPITAL OF COOK COUNTY, DEPT OF SURGERY
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City | CHICAGO
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State | IL
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Zip | 60615-2400
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Country | US
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Telephone | 312-572-2664
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Fax | 312-572-2681
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085-001953
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | MS0930241
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License Number State | IL
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