Healthcare Provider Details

I. General information

NPI: 1932604535
Provider Name (Legal Business Name): SHIBANDRI DAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 GLENRIDGE DR STE 120
ATLANTA GA
30328-5560
US

IV. Provider business mailing address

5730 GLENRIDGE DR STE 120
ATLANTA GA
30328-5560
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-1194
  • Fax: 404-252-1196
Mailing address:
  • Phone: 404-252-1194
  • Fax: 404-252-1196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number111518
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberV6908
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number430150404
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: