1073300695 NPI number — SHEILA ROXANNE SORIANO REYES PMHNP

Table of content: SHANNON M GILMORE MD (NPI 1689673006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073300695 NPI number — SHEILA ROXANNE SORIANO REYES PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYES
Provider First Name:
SHEILA ROXANNE
Provider Middle Name:
SORIANO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073300695
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
322 TERRA SPRINGS CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VOLO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60020-3204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-400-6139
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 COVENTRY LN STE 290
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRYSTAL LAKE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60014-7592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-434-4090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  209031966 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com