Provider Demographics
NPI:1790736627
Name:SHAH, SHERALEE PRADEEP (DPT)
Entity Type:Individual
Prefix:
First Name:SHERALEE
Middle Name:PRADEEP
Last Name:SHAH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 EAST OHIO
Mailing Address - Street 2:APT 3914
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:248-703-6613
Mailing Address - Fax:
Practice Address - Street 1:200 W 84TH DR STE D
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8606
Practice Address - Country:US
Practice Address - Phone:219-736-7646
Practice Address - Fax:219-736-7643
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist