Healthcare Provider Details

I. General information

NPI: 1356878896
Provider Name (Legal Business Name): SHIVANI KETAN SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA169799
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License Number100787
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: