Provider Demographics
NPI:1730258492
Name:CHAWDA, SHELLA PATEL (NP)
Entity type:Individual
Prefix:
First Name:SHELLA
Middle Name:PATEL
Last Name:CHAWDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 CLIFTON RD NE
Mailing Address - Street 2:BOX M-7
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1059
Mailing Address - Country:US
Mailing Address - Phone:404-788-0020
Mailing Address - Fax:404-778-5495
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:BOX M-7
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1059
Practice Address - Country:US
Practice Address - Phone:404-788-0020
Practice Address - Fax:404-778-5495
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN199289363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037405200Medicaid
DC018818M83Medicare ID - Type Unspecified
DC037405200Medicaid