=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750207924
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA M SHETHWALA DNP, ACNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2026
-----------------------------------------------------
Last Update Date | 06/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5841 S MARYLAND AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60637-1443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-704-6706
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7313 BLACKSTONE AVE
-----------------------------------------------------
City | JUSTICE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60458-1020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-704-6706
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine Nurse Practitioner
-----------------------------------------------------
License Number | 209.035129
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------