Provider Demographics
NPI:1568868933
Name:SHINAUL, ANTOIN DESHAUN
Entity Type:Individual
Prefix:MR
First Name:ANTOIN
Middle Name:DESHAUN
Last Name:SHINAUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5381 BURR OAK RD
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2107
Mailing Address - Country:US
Mailing Address - Phone:773-543-1752
Mailing Address - Fax:
Practice Address - Street 1:205 W WACKER DR STE 1020
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-1452
Practice Address - Country:US
Practice Address - Phone:312-640-0329
Practice Address - Fax:312-640-0407
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960035012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer