Provider Demographics
NPI:1336861384
Name:SHEDBALKER, SHAHEEN
Entity Type:Individual
Prefix:
First Name:SHAHEEN
Middle Name:
Last Name:SHEDBALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E 22ND ST STE 217
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6108
Mailing Address - Country:US
Mailing Address - Phone:630-618-7789
Mailing Address - Fax:
Practice Address - Street 1:10 E 22ND ST STE 217
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-6108
Practice Address - Country:US
Practice Address - Phone:630-747-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.009704106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist