Provider Demographics
NPI:1598395899
Name:SHIGO, STEPHANIE CRISTINA (RDN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CRISTINA
Last Name:SHIGO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:CRISTINA
Other - Last Name:SANCHEZ PAREJA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN
Mailing Address - Street 1:845 N MICHIGAN AVE STE 973W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1436 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2031
Practice Address - Country:US
Practice Address - Phone:312-651-6256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-25
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.007890133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered