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General NPI Number Information
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NPI Number | 1548843345
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Entity Type | Individual
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Provider Name | SHEENA FAGOON SHUKLA
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Gender | Female
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 1901 S CALUMET AVE UNIT 1708
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City | CHICAGO
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State | IL
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Zip | 60616-6019
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Country | US
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Telephone | 630-740-1413
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 S CALUMET AVE
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City | CHICAGO
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State | IL
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Zip | 60616-6044
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Country | US
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Telephone | 630-740-1413
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 150104225
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License Number State | IL
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