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General NPI Number Information
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NPI Number | 1811332240
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Entity Type | Individual
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Provider Name | JESSICA RAE SHANAHAN PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/29/2013
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 486 RANDALL RD UNIT B
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-3354
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Country | US
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Telephone | 224-783-5000
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Fax | 224-361-4306
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Provider Business Mailing Address
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Address Line | 25 N WINFIELD RD STE 520
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City | WINFIELD
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State | IL
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Zip | 60190-1379
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Country | US
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Telephone | 630-933-6930
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Fax | 630-933-2009
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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 | 085004648
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License Number State | IL
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