Provider Demographics
NPI:1952668600
Name:SHIBA, MONIKA URBAN (PSYD)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:URBAN
Last Name:SHIBA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-5748
Mailing Address - Country:US
Mailing Address - Phone:847-868-0218
Mailing Address - Fax:
Practice Address - Street 1:420 LAKE COOK RD
Practice Address - Street 2:STE 118
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4914
Practice Address - Country:US
Practice Address - Phone:847-868-0218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2018-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008325103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist