Provider Demographics
NPI:1467636142
Name:CIRINCIONE-ULEZI, NASIAH
Entity Type:Individual
Prefix:DR
First Name:NASIAH
Middle Name:
Last Name:CIRINCIONE-ULEZI
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:SHAWN
Other - Middle Name:VIRGINIA
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD
Mailing Address - Street 1:162 CHRISTINE WAY
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-6137
Mailing Address - Country:US
Mailing Address - Phone:630-400-1356
Mailing Address - Fax:
Practice Address - Street 1:162 CHRISTINE WAY
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-6137
Practice Address - Country:US
Practice Address - Phone:630-400-1356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X, 171W00000X, 222Q00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist
No171W00000XOther Service ProvidersContractor
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist