Provider Demographics
NPI:1437966975
Name:CLAUSELL, SHANE
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:CLAUSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PARK AVE APT 439
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5028
Mailing Address - Country:US
Mailing Address - Phone:224-421-5480
Mailing Address - Fax:
Practice Address - Street 1:1046 STERLING AVE
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1234
Practice Address - Country:US
Practice Address - Phone:708-365-6162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist