Active NPI
Tevyn Cole Shadlyn, M.D.
- Student in an Organized Health Care Education/Training Program
- Chicago, IL
National Provider Identifier
1053166447
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 820 South Wood Street
Suite 100, MC 675
Chicago, IL 60612 - Phone
- (312) 996-2933
- NPI assigned
- Apr 19, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
820 South Wood Street
Suite 100, MC 675
Chicago, IL 60612
Mailing address
820 South Wood Street
Suite 100, MC 675
Chicago, IL 60612
Phone (312) 996-2933
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
Interoperability endpoints
- tshadlyn170957@uihealth.direct-ci.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730764800000",
"number": "1053166447",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 SOUTH WOOD STREET",
"address_2": "SUITE 100, MC 675",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60612",
"telephone_number": "312-996-2933"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 SOUTH WOOD STREET",
"address_2": "SUITE 100, MC 675",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60612",
"telephone_number": "312-996-2933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHADLYN",
"first_name": "TEVYN",
"middle_name": "COLE",
"name_prefix": "Mr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-19",
"last_updated": "2024-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.