Provider Demographics
NPI:1417783655
Name:DANIEL, SHEEBA (PHD)
Entity type:Individual
Prefix:DR
First Name:SHEEBA
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHEEBA
Other - Middle Name:
Other - Last Name:DANIEL-CROTTY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2433 W WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618
Mailing Address - Country:US
Mailing Address - Phone:773-824-5816
Mailing Address - Fax:
Practice Address - Street 1:4905 OLD ORCHARD CTR STE 510
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4736
Practice Address - Country:US
Practice Address - Phone:847-484-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006295103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical