Provider Demographics
NPI:1437718335
Name:VELLOOKUNNEL, SHILPA (PA-C)
Entity Type:Individual
Prefix:
First Name:SHILPA
Middle Name:
Last Name:VELLOOKUNNEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8706 W DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5146
Mailing Address - Country:US
Mailing Address - Phone:224-392-1384
Mailing Address - Fax:
Practice Address - Street 1:675 N SAINT CLAIR ST STE 15-200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5967
Practice Address - Country:US
Practice Address - Phone:312-695-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL085.007170363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program