Kenneth John Shields Jr.

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

140 S River St Unit 102
Aurora, IL 60506

Phone

(773) 644-7787

NPI assigned

Sep 28, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680739200000",
    "number": "1134736895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8609 W BRYN MAWR AVE STE 204",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606313524",
            "telephone_number": "773-644-7787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 S RIVER ST UNIT 102",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "60506",
            "telephone_number": "773-644-7787"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "742 Essington Rd",
            "address_purpose": "LOCATION",
            "city": "Joliet",
            "state": "IL",
            "postal_code": "604354912",
            "country_code": "US",
            "telephone_number": "815-729-2160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIELDS",
        "first_name": "KENNETH",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-09-28",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Jeffrey Sherrow, M.D.
• Susan M Sherry
• Anisha Ram Shetty, M.D.
• Ramya Shetty, DDS
• Shields Behavioral Health Services LLC
• Hyun Sam Shin, DDS
• Olatokunbo Shobande, M.D.
• Segun Sadique Shonibare, CRNA, MS
• Shoptikal LLC
• Jaime Catherine Show, MS CCC-SLP

• Behavior Analyst in Aurora, IL
• Providers in Aurora, IL by specialty
• Behavior Analyst in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.