SERENDESTINY ENTERPRISE LLC (NPI# 1043474893) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043474893 |
| Entity Type | Organization |
| Organization Name | SERENDESTINY ENTERPRISE LLC |
| Practice Address |
3555 Vanilla Grass Dr Naperville IL 60564-8331 |
| Mailing Address |
355 Vanilla Grass Drive Naperville IL 60564-8331 |
| Practice Telephone | 6309223922 |
| Practice Fax Number | 6309223923 |
| Mailing Telephone | 6309223922 |
| Mailing Fax Number | 6309223923 |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2008-07-10 |
| Authorized Official Name | DR. LYDIA DIZON JAZMINES (PRESIDENT) |
| Authorized Official Telephone | 6309223922 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207SG0201X |
Medical Genetics Specialization: Clinical Genetics (M.D.) |
036055400 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036055400 | 05 |
| Street Address |
3555 VANILLA GRASS DR |
| City | NAPERVILLE |
| State | IL |
| Zip Code | 60564-8331 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215598842 | Jennifer A Mcgill | Speech-Language Pathologist | Sovereign Pediatric Therapy, 1315 Macom Dr #103, Naperville, IL 60564 | 2019-06-25 |
| 1083187660 | Erin Michelle Hankins | Counselor | 2132 Deep Water Lane, Suite # 240, Naperville, IL 60564 | 2019-01-07 |
| 1851873905 | Helen A Bruckner | Student in an Organized Health Care Education/Training Program | 28w154 Country View Dr., Naperville, IL 60564 | 2018-09-05 |
| 1912483074 | Kristina Kochanova | Psychologist | 3380 Lacrosse Lane, Suites 106-107, Naperville, IL 60564 | 2018-07-12 |
| 1831608397 | Courtney Srum | Speech-Language Pathologist | Graham Elementary School 2315 High Meadow Rd., Naperville, IL 60564 | 2017-09-27 |
| 1447707880 | Isabel Betancourt | Registered Nurse | 1315 Macom Dr Ste 5, Naperville, IL 60564 | 2016-09-01 |
| 1134577802 | Rosa Maria Felix-jones | Massage Therapist | 3420 Lacrosse, Suite 100, Unit 2 & 3, Naperville, IL 60564 | 2016-06-02 |
| 1245618412 | Ian E Evans | Counselor | 2948 Artesian Rd., Suite 112, Naperville, IL 60564 | 2015-05-08 |
| 1093114498 | Sovereign Rehab | Clinic/Center | 1315 Macom Dr. Suite 103, Naperville, IL 60564 | 2014-08-21 |
| 1154745891 | Antonina Rosaria Sullivan | Occupational Therapist | 10350 Brenner Ct, Naperville, IL 60564 | 2014-02-18 |
| Find all providers in zip 60564 | ||||
| Taxonomy Code | 207SG0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Medical Genetics |
| Specialization | Clinical Genetics (M.D.) |
| A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Medical Genetics, 2007. http://www.abmg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164447413 | Lee Shulman | Medical Genetics | 675 N St Clair Street, Galter Suite 14-200, Chicago, IL 60611-5966 | 2006-07-13 |
| 1962466375 | Joel Martin Charrow | Medical Genetics | Ann& Robert H. Lurie Children's Hospital of Chicago #59, 225 E Chicago Ave, Chicago, IL 60611-2991 | 2006-04-13 |
| 1427026897 | Brad Angle | Medical Genetics | 1875 Dempster St Ste 285, Park Ridge, IL 60068-1157 | 2006-03-10 |
| 1629051289 | Rhonda Spiro | Medical Genetics | 1801 W Taylor St Ste 2e, Chicago, IL 60612-4795 | 2005-11-28 |
| 1134534597 | Joshua Baker | Medical Genetics | 225 E Chicago Ave, Chicago, IL 60611-2991 | 2014-06-24 |
| 1306108105 | Josue Flores Daboub | Medical Genetics | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2012-06-08 |
| 1972883254 | Gifty Bhat | Medical Genetics | 1801 W Taylor St Ste 2e, Ui Health Occ, Chicago, IL 60612-4795 | 2011-08-18 |
| 1043410772 | Neuromed Clinic LLC | Medical Genetics | 25 N Winfield Rd, Ste 500, Winfield, IL 60190-1222 | 2007-07-20 |
| 1669595872 | Darrel Waggoner | Medical Genetics | 5841 S Maryland Ave, Mc 0077 Room O-500, Chicago, IL 60637-1447 | 2007-04-10 |
| 1538282736 | William Brian Dobyns | Medical Genetics | 5841 S Maryland Ave, Mc 0077, Chicago, IL 60637-1447 | 2007-04-10 |
| Find all providers with the same taxonomy | ||||
| City | NAPERVILLE |
| Zip Code | 60564 |
Please comment or provide details below to improve the information on SERENDESTINY ENTERPRISE LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.