| Doctor Name: | DR. SHAHEDA M MANSURI |
| NPI Number: | 1598701401 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | |
| Business Practice Address: | 2401 W Main St Vamedical Center Marion, IL - 629591188 |
| Business Phone Number: | 6189934183 |
| Business Fax Number: | 6189985677 |
| Mailing Address: | 2401 W Main St, Vamedical Center MARION |
| State: | IL |
| Postal Code: | 629591188 |
| Phone Number: | 6189934183 |
| Fax Number: | 6189985677 |
| NPI Enumeration Date: | 06/20/2006 |
| NPI Last Update Date: | 07/13/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |