Provider Demographics
NPI:1184857500
Name:SHONIBARE, SEGUN SADIQUE (CRNA, MS)
Entity Type:Individual
Prefix:MR
First Name:SEGUN
Middle Name:SADIQUE
Last Name:SHONIBARE
Suffix:
Gender:M
Credentials:CRNA, MS
Other - Prefix:
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Mailing Address - Street 1:400 E 33RD ST
Mailing Address - Street 2:APT# 2005
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4055
Mailing Address - Country:US
Mailing Address - Phone:773-263-4812
Mailing Address - Fax:
Practice Address - Street 1:1325 N HIGHLAND AVE
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1449
Practice Address - Country:US
Practice Address - Phone:630-859-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209007761367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered