MEDICARE: ALEEN SHAH PA-C

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	2084P0802X	Addiction Psychiatry Physician	XS3247245	IL
2	363AM0700X	Medical Physician Assistant	085-005058	IL
3	363A00000X	Physician Assistant	085005058	IL
4	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	XS3247245	IL
5	2084P0800X	Psychiatry Physician	085-005058	IL

General Provider Information

NPI Number	:	1942612668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEEN SHAH PA-C

Provider Business Mailing Address
First Line	:	145 S VIRGINIA ST
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7226
Country	:	US
Telephone Number	:	815-444-9999
Fax Number	:	815-986-1363

Provider Business Practice Location Address
First Line	:	145 S VIRGINIA ST
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-7226
Country	:	US
Telephone Number	:	815-444-9999
Fax Number	:	815-986-1363

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

Provider Enumeration Date	:	05/29/2014
Last Update Date	:	01/12/2023

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Directions to “ ALEEN SHAH PA-C” Practice Location

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