MEDICARE: ANDREA SHANE MD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0208X	Pediatric Infectious Diseases Physician	58010	GA

General Provider Information

NPI Number	:	1811959356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA SHANE MD, MPH

Provider Business Mailing Address
First Line	:	1400 TULLIE RD NE FL 2
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2309
Country	:	US
Telephone Number	:	404-785-5437
Fax Number	:	404-785-9111

Provider Business Practice Location Address
First Line	:	1400 TULLIE RD NE FL 2
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2309
Country	:	US
Telephone Number	:	404-785-5437
Fax Number	:	404-785-9111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	06/06/2022

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