Provider Demographics
NPI:1902194822
Name:VAUGHN, SHANELE MCGOWAN (MD)
Entity type:Individual
Prefix:DR
First Name:SHANELE
Middle Name:MCGOWAN
Last Name:VAUGHN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16008
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-0001
Mailing Address - Country:US
Mailing Address - Phone:708-972-9695
Mailing Address - Fax:708-576-8491
Practice Address - Street 1:5571 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2356
Practice Address - Country:US
Practice Address - Phone:708-972-9695
Practice Address - Fax:708-401-0194
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00276032084N0400X, 2084P2900X
IL0361362612084N0400X, 208VP0014X
NC2025-003472084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine