Shahrbanoo Fadavi, D.D.S.,M.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Practice address

4833 Church St
801 S. Polina
Skokie, IL 60077-1357

Phone

(847) 673-7118

NPI assigned

Oct 16, 2006

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

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

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

• The Board of Trustees of the University of Illinois

  • Anatomic Pathology Physician
  • Chicago, IL
  • NPI 1386863819
  Medicare reassignment NPD
• Board of Trustees of the University of Illinois

  • Dentist
  • Chicago, IL
  • NPI 1992873921
  NPD
• The Board of Trustees of the University of Illinois

  • Occupational Medicine Physician
  • Chicago, IL
  • NPI 1043727571
  NPD

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750461737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2429 MEADOW DR N",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4833 CHURCH ST",
            "address_2": "801 S. POLINA",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771357",
            "telephone_number": "847-673-7118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FADAVI",
        "first_name": "SHAHRBANOO",
        "credential": "D.D.S.,M.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Eyber, DDS
• Eye Care LTD
• Eye Care LTD
• Eyes of Grace SC
• Fabio Ortega MD SC
• Fagman Eye Surgery Associates
• Jan H. Faibisoff, M.D.
• Allison Paige Fair, OTR/L
• Joel Andrew Falco
• Family Doctors/Family Healthcare

• Pediatric Dentistry in Skokie, IL
• Providers in Skokie, IL by specialty
• Pediatric Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.