Provider Demographics
NPI:1720036528
Name:NYAEME, SHAHLA MAJID (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHLA
Middle Name:MAJID
Last Name:NYAEME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAHLA
Other - Middle Name:
Other - Last Name:HAMEED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:6101 S COUNTY LINE RD
Practice Address - Street 2:CLINIC
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-8132
Practice Address - Country:US
Practice Address - Phone:630-686-9000
Practice Address - Fax:844-235-2578
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111455207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208341OtherMEDICARE GROUP NUMBER
IL208342OtherMEDICARE GROUP NUMBER
ILF100323989OtherGROUP MEDICARE PTAN
ILK22479Medicare PIN
IL208341OtherMEDICARE GROUP NUMBER
IL208342OtherMEDICARE GROUP NUMBER
IL0361114551Medicaid