Provider Demographics
NPI:1649407065
Name:ZOMAYA, NANCY (DPM)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:ZOMAYA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:ZOMAYA SHUNNESON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:917 CRESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3019
Mailing Address - Country:US
Mailing Address - Phone:847-912-6141
Mailing Address - Fax:224-513-4394
Practice Address - Street 1:6201 W TOUHY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646
Practice Address - Country:US
Practice Address - Phone:847-673-5166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005444213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005444Medicaid