SHOBHA NOOKALA MD NPI 1154336691

NPI Information

NPI: 1154336691
Provider Name: SHOBHA NOOKALA, MD
Classification: Psychiatry & Neurology - 2084P0804X
Entity Type: Individual

Specialization: Child & Adolescent Psychiatry

PECOS Registration: Yes

Address:
900 MAIN ST
SUITE 400
PEORIA, IL
ZIP 61602
Phone: (309) 672-3100
Get Directions

Shobha Nookala, MD is a child and adolescent psychiatry psychiatry neurology in Peoria, IL with 35 years of experience. The provider is child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. Shobha Nookala, MD NPI is 1154336691. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

900 MAIN ST
SUITE 400
PEORIA, IL
ZIP 61602-005
Phone: (309) 672-3100

The NPI 1154336691 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/31/2006 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2084P0804X	Psychiatry & Neurology	Child & Adolescent Psychiatry		ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	7215059	OTHER	ILLINOIS	BCBS PPO
2	088318	OTHER	ILLINOIS	HEALTH ALLIANCE
3	K04470	MEDICARE ID-TYPE UNSPECIFIED	ILLINOIS
4	H73719	MEDICARE UPIN	ILLINOIS
5	472292	OTHER	ILLINOIS	HEALTHLINK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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