Provider Demographics
NPI:1427858935
Name:GAYDEN, SHAKELA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:SHAKELA
Middle Name:
Last Name:GAYDEN
Suffix:
Gender:
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16737 94TH AVE
Mailing Address - Street 2:
Mailing Address - City:ORLAND HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60487-5986
Mailing Address - Country:US
Mailing Address - Phone:773-319-4999
Mailing Address - Fax:
Practice Address - Street 1:75 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-8137
Practice Address - Country:US
Practice Address - Phone:312-973-2554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209031895363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty