Provider Demographics
NPI:1811332240
Name:SHANAHAN, JESSICA RAE (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:SHANAHAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:486 RANDALL RD UNIT B
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-3354
Practice Address - Country:US
Practice Address - Phone:224-783-5000
Practice Address - Fax:224-361-4306
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2024-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085004648363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant