Provider Demographics
NPI:1811724685
Name:SHIBU, ANGELA
Entity type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:
Last Name:SHIBU
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 1:1606 E AVON CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4229
Mailing Address - Country:US
Mailing Address - Phone:224-435-8957
Mailing Address - Fax:
Practice Address - Street 1:1606 E AVON CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4229
Practice Address - Country:US
Practice Address - Phone:224-435-8957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician