Provider Demographics
NPI:1346982634
Name:SHAN, SYDNEY (DO)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:SHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:SYDNEY
Other - Middle Name:
Other - Last Name:HADLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:3134 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4414
Mailing Address - Country:US
Mailing Address - Phone:312-766-4949
Mailing Address - Fax:
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-684-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program