Provider Demographics
NPI:1215950415
Name:BAGRI, SHELLEY JOY (APRN, BC)
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:JOY
Last Name:BAGRI
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 MARENGO AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1707
Mailing Address - Country:US
Mailing Address - Phone:708-305-5333
Mailing Address - Fax:
Practice Address - Street 1:431 MARENGO AVE
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:IL
Practice Address - Zip Code:60130-1707
Practice Address - Country:US
Practice Address - Phone:708-305-5333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-002942363LP0200X, 363LP0808X
IL277002708363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics