Healthcare Provider Details

I. General information

NPI: 1275588139
Provider Name (Legal Business Name): SHEETAL KANDIAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE
ATLANTA GA
30308-2212
US

IV. Provider business mailing address

550 PEACHTREE ST NE
ATLANTA GA
30308-2212
US

V. Phone/Fax

Practice location:
  • Phone: 404-686-8114
  • Fax:
Mailing address:
  • Phone: 404-686-8114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number48812-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number066192
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: