| Doctor Name: | SHANNON WATLEY |
| NPI Number: | 1205821121 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DO |
| License Number: | 036106885 |
| Business Practice Address: | 360 Station Drive 3rd Floor Crystal Lake, IL - 600146260 |
| Business Phone Number: | 8154772310 |
| Business Fax Number: | 8153562335 |
| Mailing Address: | 13707 W Jackson St, WOODSTOCK |
| State: | IL |
| Postal Code: | 600983188 |
| Phone Number: | 8153371871 |
| Fax Number: | 8153386297 |
| NPI Enumeration Date: | 09/16/2005 |
| NPI Last Update Date: | 06/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | 036106885 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |