MEDICARE: NALDINE ISAAC

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	390200000X	Student in an Organized Health Care Education/Training Program	104934	GA
2	390200000X	Student in an Organized Health Care Education/Training Program	125079590	IL

General Provider Information

NPI Number	:	1295313104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NALDINE ISAAC

Provider Business Mailing Address
First Line	:	251 E HURON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2908
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 N DECATUR RD FL 3
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-5918
Country	:	US
Telephone Number	:	832-546-1365
Fax Number	:

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

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	02/17/2026

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