Individual
SHAYNA MANCUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
660 N WESTMORELAND RD, LAKE FOREST, IL 60045
(847) 535-6352
Mailing address
811 S RIDGE RD, LAKE FOREST, IL 60045-2755
(312) 399-1732
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036-112082
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036112082
—
IL
Enumeration date
07/09/2006
Last updated
10/30/2020
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