Provider Demographics
NPI:1619427069
Name:SHAH, HETA (FNP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:HETA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 SUMMERSWEET LN
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:IL
Mailing Address - Zip Code:60103-1208
Mailing Address - Country:US
Mailing Address - Phone:847-346-9269
Mailing Address - Fax:847-914-6280
Practice Address - Street 1:2815 FORBS AVE STE 107
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-3731
Practice Address - Country:US
Practice Address - Phone:847-916-7880
Practice Address - Fax:847-914-6280
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209014462363LF0000X
IL277.002736363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily