Provider Demographics
NPI:1063279917
Name:NESHEIWAT, WAJDEY (PA-C)
Entity type:Individual
Prefix:
First Name:WAJDEY
Middle Name:
Last Name:NESHEIWAT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE.
Mailing Address - Street 2:DEPT. OF SURGERY WALGREEN 2507
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-2560
Mailing Address - Fax:847-570-2930
Practice Address - Street 1:2650 RIDGE AVE.
Practice Address - Street 2:DEPT. OF SURGERY WALGREEN 2507
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-2560
Practice Address - Fax:847-570-2930
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085010519363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical