Provider Demographics
NPI:1528194131
Name:HAYES, SHELANDA CHARISE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELANDA
Middle Name:CHARISE
Last Name:HAYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13229 TRADITION DR
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-6219
Mailing Address - Country:US
Mailing Address - Phone:708-799-9700
Mailing Address - Fax:708-799-9701
Practice Address - Street 1:19740 GOVERNORS HWY
Practice Address - Street 2:STE 116
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2085
Practice Address - Country:US
Practice Address - Phone:708-799-9700
Practice Address - Fax:708-799-9701
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
IL036-108398207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
H11064Medicare UPIN