Provider Demographics
NPI:1649091380
Name:HAMILTON, SHACIARRA (PSYD)
Entity type:Individual
Prefix:
First Name:SHACIARRA
Middle Name:
Last Name:HAMILTON
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 1:2702 N SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-7835
Mailing Address - Country:US
Mailing Address - Phone:601-880-6206
Mailing Address - Fax:
Practice Address - Street 1:701 DEVONSHIRE DR STE C11
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-7352
Practice Address - Country:US
Practice Address - Phone:217-213-3405
Practice Address - Fax:214-403-9557
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.011224103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist