Provider Demographics
NPI:1912325796
Name:VERMA, SHELLY (DO)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:
Last Name:VERMA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 HARTREY AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-1056
Mailing Address - Country:US
Mailing Address - Phone:847-666-3494
Mailing Address - Fax:847-868-8964
Practice Address - Street 1:1285 HARTREY AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1056
Practice Address - Country:US
Practice Address - Phone:847-666-3494
Practice Address - Fax:847-868-8964
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO00978207Q00000X
IL036143774208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist