Shane Rafferty, MS, CCLS

Developmental - Behavioral Pediatrics Physician · Chicago, IL

Individual Active NPI

NPI number 1720625601

Practice location

4852 N Rockwell St Apt 2
Chicago, IL 60625-6521
Phone
(847) 219-1824

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NPI record

NPI
1720625601
Entity type
Individual (Type 1)
Enumeration date
December 10, 2019
Last updated
June 3, 2020
Certified
June 3, 2020
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Developmental - Behavioral Pediatrics Physician Primary 2080P0006X 21312 IL

About Shane Rafferty

Shane Rafferty, MS, CCLS is a healthcare provider registered in the NPI registry with the primary taxonomy Developmental - Behavioral Pediatrics Physician (code 2080P0006X). The practice location is 4852 N Rockwell St Apt 2, Chicago, IL 60625-6521. The NPI number 1720625601 was assigned on December 10, 2019 and the record was last updated on June 3, 2020.

Shane Rafferty lists a license in the registry: #21312 (IL) for Developmental - Behavioral Pediatrics Physician. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Shane Rafferty, MS, CCLS?

The NPI number is 1720625601.

What is the phone number of Shane Rafferty?

The phone number listed for the practice location is (847) 219-1824.

Where is Shane Rafferty located?

4852 N Rockwell St Apt 2, Chicago, IL 60625-6521.

What is the taxonomy code for Shane Rafferty?

The primary taxonomy code is 2080P0006X – Developmental - Behavioral Pediatrics Physician.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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