Provider Demographics
NPI:1346025962
Name:SHEVOKAS, OLGA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:SHEVOKAS
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 1:3303 BLACKWATER DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-0611
Mailing Address - Country:US
Mailing Address - Phone:818-156-9061
Mailing Address - Fax:
Practice Address - Street 1:3303 BLACKWATER DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-0611
Practice Address - Country:US
Practice Address - Phone:818-156-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164007267133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered