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Individual

SHAUNTAY ROBERTSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
7342 S RICHMOND ST, CHICAGO, IL 60629-3015
(773) 671-4854
Mailing address
7342 S RICHMOND ST, CHICAGO, IL 60629-3015

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
011271944
IL

Other

Enumeration date
03/19/2018
Last updated
03/19/2018
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