Shawnice Y Waight
Individual provider Active NPI Contractor · Sauk Village, IL
NPI 1124253885 · NPPES record last updated May 26, 2009
Key facts
- NPI
- 1124253885
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 21645 Olivia Ave
Sauk Village, IL 60411-4426 - Phone
- (708) 748-5700
- Fax
- (708) 748-4245
- NPI assigned
- May 26, 2009
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
21645 Olivia Ave
Sauk Village, IL 60411-4426
Mailing address
21645 Olivia Ave
Sauk Village, IL 60411-4426
Phone (708) 748-5700
Other providers in Sauk Village, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 26, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.