Individual
SHAVON MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8906 S BENNETT AVE, CHICAGO, IL 60617-2917
(773) 269-0040
Mailing address
8906 S BENNETT AVE, CHICAGO, IL 60617-2917
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
NA
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
06/21/2021
Last updated
06/21/2021
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