Individual provider Active NPI

Sheila Mander, PSY.D.

  • Clinical Psychologist
  • Chicago, IL
National Provider Identifier
1750051785
Registry record updated Sep 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071.010109 Issued in IL
Practice address
405 N Wabash Ave Unit 1114
Chicago, IL 60611-3597
Phone
(732) 908-0236
NPI assigned
Sep 21, 2021
Last updated
Sep 21, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 024072-01 NY
Clinical Psychologist 103TC0700X 071.010109 IL Primary

Addresses

Primary practice location

405 N Wabash Ave Unit 1114
Chicago, IL 60611-3597

Mailing address

405 N Wabash Ave Unit 1114
Chicago, IL 60611-3597

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231010000894 IL Practitioner - Clinical Psychologist 9830544915 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Edgewood Clinical Services P.C.Group PAC ID 3971963901, 304 clinicians

Practice addresses (Care Compare)

2071 N Southport Ave
Suite 100
Chicago, IL 60614-4015
Phone (888) 428-7890

808 S Eldorado Rd
Suite 102
Bloomington, IL 61704-6075
Phone (888) 428-7890

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
024072-01NYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Edgewood Clinical Services, P.C. CurrentSince Aug 7, 2023 Accepting new patients
Psychology Specialists LTD Clinical Past Accepting new patients

Locations

808 S Eldorado Rd
Ste 102
Bloomington, IL 61704
Phone (309) 212-6007

2948 Artesian Rd
Ste 112
Naperville, IL 60564
Phone (630) 328-0165

3027 English Rows Ave
Ste 201
Naperville, IL 60564

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1632182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632182400000",
    "number": "1750051785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 N WABASH AVE UNIT 1114",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 N WABASH AVE UNIT 1114",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113597",
            "telephone_number": "732-908-0236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDER",
        "first_name": "SHEILA",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-21",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "024072-01",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.010109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.