Active NPI
Serene Shashaa, M.D.
- Specialist
- Chicago, IL
National Provider Identifier
1568635951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Practice address
- 1725 W Harrison St
Suite 054
Chicago, IL 60612-3841 - Phone
- (312) 942-4603
- NPI assigned
- Apr 8, 2008
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | IL | Primary |
Addresses
Primary practice location
1725 W Harrison St
Suite 054
Chicago, IL 60612-3841
Mailing address
21 W Chestnut St
Apt 809
Chicago, IL 60610-3308
Phone (312) 943-6884
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-113543 | IL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207612800000",
"number": "1568635951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 W CHESTNUT ST",
"address_2": "APT 809",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606103308",
"telephone_number": "312-943-6884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1725 W HARRISON ST",
"address_2": "SUITE 054",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123841",
"telephone_number": "312-942-4603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHASHAA",
"first_name": "SERENE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-08",
"last_updated": "2008-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "IL",
"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 Apr 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.