Active NPI
Shiny Mathew Nanthikattu
- Family Nurse Practitioner
- Naperville, IL
National Provider Identifier
1285101865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 209018424
- Practice address
- 2614 Modaff Rd
Naperville, IL 60565-4342 - Phone
- (630) 885-6721
- NPI assigned
- Oct 31, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209018424 | IL | Primary |
Addresses
Primary practice location
2614 Modaff Rd
Naperville, IL 60565-4342
Mailing address
2614 Modaff Rd
Naperville, IL 60565-4342
Phone (163) 088-5672
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209018424 | IL | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540944000000",
"number": "1285101865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2614 MODAFF RD",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605654342",
"telephone_number": "163-088-5672"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2614 MODAFF RD",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605654342",
"telephone_number": "630-885-6721"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NANTHIKATTU",
"first_name": "SHINY",
"middle_name": "MATHEW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-31",
"last_updated": "2018-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": "IL",
"license": "209018424",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Naperville, IL
- Krishna Nagendran, MD
- Lata J Nagpal, MD
- Nikhat Nahar Rafiq, LPC
- Sandhya Nair, LCSW
- Lea Nanninga, PHARMD
- Naper Clinical Behavioral Services Inc
- Naper Dental Sleep Center, LTD
- Naper Grove Vision Care, P.C. (Naper Grove Vision Care)
- Naperville Center for Health & Wellness
- Naperville Center for Sleep Health LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.