Provider Demographics
NPI:1538317888
Name:SANDHYA, SHAIFALI
Entity Type:Individual
Prefix:DR
First Name:SHAIFALI
Middle Name:
Last Name:SANDHYA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SHAIFALI
Other - Middle Name:
Other - Last Name:SANDHYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:233 EAST ERIE, SUITE 409
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:773-818-6717
Mailing Address - Fax:
Practice Address - Street 1:233 EAST ERIE, SUITE 409
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:773-818-6717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007434103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL26-2249868OtherTAX ID