Shayna Mancuso, D.O.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

036-112082 Issued in IL

Practice address

660 N Westmoreland Rd
Lake Forest, IL 60045

Phone

(847) 535-6352

NPI assigned

Jul 9, 2006

Last updated

Oct 30, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shayna Hollingsworth Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: smancuso277101@direct.northshore.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northwestern Memorial Physicians Group

  dba NMPG

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1538111299

  Obstetrics & Gynecology

  NPD (past)

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604016000000",
    "number": "1558394510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 S RIDGE RD",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600452755",
            "telephone_number": "312-399-1732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 N WESTMORELAND RD",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "60045",
            "telephone_number": "847-535-6352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCUSO",
        "first_name": "SHAYNA",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-09",
        "last_updated": "2020-10-30",
        "certification_date": "2020-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036-112082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036112082",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smancuso277101@direct.northshore.org",
            "affiliation": "N",
            "address_1": "660 N Westmoreland Rd",
            "city": "Lake Forest",
            "state": "IL",
            "country_code": "US",
            "postal_code": "60045",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "SHAYNA",
            "last_name": "HOLLINGSWORTH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Aaron Charles Malina, PH.D.
• Julia Margret Malloy, NP-C
• Michaela Malone
• Sara N. Mammoser, PT/DPT
• Jackson Mancuso, LPC
• Priyal P Mangrola, DMD
• Corinne Manny
• Shana Leah Margolis, M.D.
• Deborah M Margulis, MD
• Marine One, LLC (Marine 1 Transit)

• Obstetrics & Gynecology Physician in Lake Forest, IL
• Providers in Lake Forest, IL by specialty
• Obstetrics & Gynecology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2020; 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.