Provider Demographics
NPI:1821400714
Name:HUNT, SHANNON BARBARA (MD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:BARBARA
Last Name:HUNT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:BARBARA
Other - Last Name:DIBBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1001 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2811
Mailing Address - Country:US
Mailing Address - Phone:630-963-3937
Mailing Address - Fax:630-963-6802
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:LOYOLA OUTPATIENT CENTER, 4300
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-216-6006
Practice Address - Fax:708-216-2683
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.064577207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology