Provider Demographics
NPI:1992856678
Name:CHHABRIA, SHAKUNTALA (MD)
Entity Type:Individual
Prefix:
First Name:SHAKUNTALA
Middle Name:
Last Name:CHHABRIA
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 1:222 SOUTH GREENLEAF STREET SUITE 111
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5705
Mailing Address - Country:US
Mailing Address - Phone:847-587-6112
Mailing Address - Fax:847-587-6113
Practice Address - Street 1:222S GREENLEAF ST 111
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5705
Practice Address - Country:US
Practice Address - Phone:847-360-0044
Practice Address - Fax:847-360-8804
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360531492084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053149Medicaid
ILP00275220OtherRAIL ROAD MEDICARE
IL4900918OtherBLUE CROSS BLUE SHIELD
IL4900918OtherBLUE CROSS BLUE SHIELD