MR. KETAN MAHENDRA SHAH (NPI# 1689959900) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689959900 |
| Entity Type | Individual |
| Full Name | MR. KETAN MAHENDRA SHAH |
| Credential | PMHNP-BC |
| Practice Address |
422 N Prospect St Wheaton IL 60187-5839 |
| Practice Telephone | 6306827400 |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2011-10-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
209008868 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407137102 | Ketan H Shah | Pharmacist | 153 Wood Ave, Edison, NJ 08820-3504 | 2011-09-08 |
| 1841306693 | Ketan Shah | Otolaryngology | 1000 Eleven S, Ste 4f, Columbia, IL 62236-1080 | 2006-08-22 |
| 1609822360 | Ketan D. Shah | Podiatrist | 9234 Kennedy Blvd, North Bergen, NJ 07047-5312 | 2006-05-25 |
| 1144575788 | Ketan Yogesh Shah | Internal Medicine | 5841 S Maryland Ave, Chicago, IL 60637-1447 | 2012-07-19 |
| 1922390210 | Ketan R Shah | Nurse Anesthetist, Certified Registered | 3200 Tyre Neck Rd, Suite 101, Portsmouth, VA 23703-3329 | 2011-05-05 |
| 1790001535 | Ketan Vikrambhai Shah | Internal Medicine | 300 Highland Ave, Hanover, PA 17331-2297 | 2010-04-19 |
| 1629244652 | Ketan K Shah | Internal Medicine | 24221 Calle De La Louisa, Suite 300, Laguna Hills, CA 92653-7638 | 2008-04-30 |
| 1871507053 | Ketan Shah | Internal Medicine | 5500 Armstrong Rd, Battle Creek, MI 49015-1014 | 2006-07-27 |
| 1528098134 | Ketan Shah | Internal Medicine | 2211 E Franklin Blvd, Ste 100, Gastonia, NC 28054-4985 | 2006-07-03 |
| 1083664023 | Ketan S. Shah | Internal Medicine | 3120 Governors Place Blvd, Dayton, OH 45409-1328 | 2006-05-11 |
| Street Address |
422 N PROSPECT ST |
| City | WHEATON |
| State | IL |
| Zip Code | 60187-5839 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386061505 | Andrea Monroe | Counselor | 422 N Prospect St, Wheaton, IL 60187-5839 | 2014-03-26 |
| 1669730362 | Nancy Kelly | Case Manager/Care Coordinator | 422 N Prospect St, Wheaton, IL 60187-5839 | 2012-05-01 |
| 1477811164 | Jim Doyle | Case Manager/Care Coordinator | 422 N Prospect St, Wheaton, IL 60187-5839 | 2012-05-01 |
| 1518231661 | Sandra Jo Mazurek | Case Manager/Care Coordinator | 422 N Prospect St, Wheaton, IL 60187-5839 | 2012-03-06 |
| 1669746848 | Thomas Brown | Case Manager/Care Coordinator | 422 N Prospect St, Wheaton, IL 60187-5839 | 2012-03-06 |
| 1598039133 | Lynn Thurman | Case Manager/Care Coordinator | 422 N Prospect St, Wheaton, IL 60187-5839 | 2012-02-29 |
| 1770857310 | Jennifer Lawson | Case Manager/Care Coordinator | 422 N Prospect St, Wheaton, IL 60187-5839 | 2012-02-29 |
| 1508130261 | Katherine Lenahan | Counselor | 422 N Prospect St, Wheaton, IL 60187-5839 | 2012-02-28 |
| 1710251483 | Jennifer Atten | Counselor | 422 N Prospect St, Wheaton, IL 60187-5839 | 2012-02-28 |
| 1548534142 | Betty Verhaeghe | Registered Nurse | 422 N Prospect St, Wheaton, IL 60187-5839 | 2012-02-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811510738 | Arielle Susan Kalvelage | Counselor | Central Public Health Center (cphc), 111 N. County Farm Road, Wheaton, IL 60187 | 2020-05-27 |
| 1801418363 | Peter Gerard Harvey | Acupuncturist | 200 East Willow Avenue, Suite 202, Wheaton, IL 60187 | 2020-05-07 |
| 1760028823 | Teresa Clasen | Counselor | 222 Willow Ave, Wheaton, IL 60187 | 2019-11-25 |
| 1821630757 | Eastern Healing Inc. | Acupuncturist | 200 E. Willow Ave., Suite 202, Wheaton, IL 60187 | 2019-10-11 |
| 1952816282 | Caprishea Jones | Counselor | 111 N County Farm Road, Wheaton, IL 60187 | 2017-12-08 |
| 1265880330 | Bryan Cairncross | Specialist/Technologist | 1503 Beecher Ave., Wheaton, IL 60187 | 2016-05-31 |
| 1811357544 | Patricia Diaz | Nurse Practitioner | 0n620 West Street, Wheaton, IL 60187 | 2016-02-23 |
| 1962819227 | Breakthrough Care Center | Clinic/Center | 150 E. Willow Ave, Ste 100, Wheaton, IL 60187 | 2014-07-18 |
| 1780005587 | Kyler Mulhauser | Counselor | 600 W. Roosevelt Rd, Suite A2, Wheaton, IL 60187 | 2013-12-20 |
| 1538593074 | Deborah Bates | Psychologist | 300 E Roosevelt Rd Ste 105, Wheaton, IL 60187 | 2013-08-31 |
| Find all providers in zip 60187 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497259527 | Joseph Zillur Rahman | Nurse Practitioner | 2100 Manchester Rd Ste 1510, Wheaton, IL 60187-4561 | 2018-03-22 |
| 1619480159 | Tara Krisch | Nurse Practitioner | 111 N County Farm Rd, Wheaton, IL 60187-3977 | 2017-11-07 |
| 1114383213 | Maryellen Fleming-price | Nurse Practitioner | 1725 S Naperville Rd Ste 206, Wheaton, IL 60189-5855 | 2016-01-06 |
| 1528440930 | Susan Dunne | Nurse Practitioner | 111 N County Farm Rd, Wheaton, IL 60187-3977 | 2015-06-22 |
| 1821161886 | Sharon Diehl Beck | Nurse Practitioner | 1761 S Naperville Rd, Ste 200, Wheaton, IL 60189-5846 | 2006-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790384451 | Ghea Tiping Degillo | Nurse Practitioner | 4711 Golf Rd Ste 500, Skokie, IL 60076-1208 | 2020-10-22 |
| 1750989620 | Rodney J Pena Jr. | Nurse Practitioner | 1362 Trotters Ln, Bourbonnais, IL 60914-4519 | 2020-10-13 |
| 1609482231 | Crystal Lynn Jordan | Nurse Practitioner | 638 Oakbrook Ave, Chatham, IL 62629 | 2020-09-18 |
| 1497369672 | Mojisola Abayemi Akinfe | Nurse Practitioner | 8572 Stone Creek Blvd, Frankfort, IL 60423-9338 | 2020-09-03 |
| 1508475039 | Hilary Eichie | Nurse Practitioner | 20025 Division St., Crest Hill, IL 60403 | 2020-07-30 |
| 1518585942 | Tabs Behavioral Health Inc | Nurse Practitioner | 13316 Vicarage Dr, Plainfield, IL 60585-5050 | 2020-07-13 |
| 1154946788 | Latisha Trenice Stennis | Nurse Practitioner | 8106 Carol Dr, East Saint Louis, IL 62203-1838 | 2020-06-09 |
| 1114549755 | Maria Andreea Bordeianu | Nurse Practitioner | 6050 N California Ave, Chicago, IL 60659-3916 | 2020-05-16 |
| 1104448968 | Abosede Rachel Babalola | Nurse Practitioner | 2214 Monarch St, Bourbonnais, IL 60914-2780 | 2020-05-14 |
| 1659909406 | Mudira Temilola Oyewole | Nurse Practitioner | 493 Leslie Ct, Des Plaines, IL 60016-8818 | 2020-03-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.