Provider Demographics
NPI:1790551893
Name:SHANAHAN-RICHARDS, WENDY (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:SHANAHAN-RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:728 W JACKSON BLVD APT 412
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5304
Mailing Address - Country:US
Mailing Address - Phone:312-622-3946
Mailing Address - Fax:
Practice Address - Street 1:333 W WACKER DR STE 2100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-2210
Practice Address - Country:US
Practice Address - Phone:312-622-3946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine