Provider Demographics
NPI:1548933120
Name:SHAH, ISHANIBEN
Entity type:Individual
Prefix:
First Name:ISHANIBEN
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5978 N LINCOLN AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3747
Mailing Address - Country:US
Mailing Address - Phone:773-554-2989
Mailing Address - Fax:
Practice Address - Street 1:5978 N LINCOLN AVE APT 1D
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3747
Practice Address - Country:US
Practice Address - Phone:773-554-2989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist