MEDICARE: SHAMEL COLVARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209029279	IL
2	363LF0000X	Family Nurse Practitioner	041450134	IL

General Provider Information

NPI Number	:	1225806094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAMEL COLVARD

Provider Business Mailing Address
First Line	:	4847 W WASHINGTON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-3628
Country	:	US
Telephone Number	:	312-504-0144
Fax Number	:

Provider Business Practice Location Address
First Line	:	4847 W WASHINGTON BLVD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-3628
Country	:	US
Telephone Number	:	312-504-0144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2023
Last Update Date	:	01/10/2026

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Directions to “ SHAMEL COLVARD ” Practice Location

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