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General NPI Number Information
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NPI Number | 1508993031
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Entity Type | Individual
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Provider Name | REGINA MARIE SHASHA APN
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Gender | Female
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 03/15/2021
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Provider Practice Location Address
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Address Line | 734 W 47TH ST
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City | CHICAGO
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State | IL
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Zip | 60609-4411
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Country | US
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Telephone | 773-537-3161
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Fax |
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Provider Business Mailing Address
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Address Line | 4101 N RAVENSWOOD AVE
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City | CHICAGO
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State | IL
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Zip | 60613-2193
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Country | US
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Telephone | 773-572-5224
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Fax | 773-537-3437
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 277000129
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 277000129
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License Number State | IL
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