Provider Demographics
NPI:1275216558
Name:FEJZA, SHASEME (DNP, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:SHASEME
Middle Name:
Last Name:FEJZA
Suffix:
Gender:F
Credentials:DNP, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 WOODBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-2499
Mailing Address - Country:US
Mailing Address - Phone:631-697-9081
Mailing Address - Fax:
Practice Address - Street 1:1800 HOLLISTER DR STE 220
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5266
Practice Address - Country:US
Practice Address - Phone:847-362-5707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.023874363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics