Provider Demographics
NPI:1659373355
Name:SHEVELEV, TAIYA (DO)
Entity Type:Individual
Prefix:
First Name:TAIYA
Middle Name:
Last Name:SHEVELEV
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6905
Mailing Address - Country:US
Mailing Address - Phone:847-419-1900
Mailing Address - Fax:847-419-1964
Practice Address - Street 1:201 E STRONG ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-2979
Practice Address - Country:US
Practice Address - Phone:847-419-1900
Practice Address - Fax:847-419-1964
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101744207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology