Healthcare Provider Details

I. General information

NPI: 1063983773
Provider Name (Legal Business Name): SHADIA RUBIO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2018
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2292 PEACHTREE RD NW
ATLANTA GA
30309-1147
US

IV. Provider business mailing address

13277 NW 10TH ST
MIAMI FL
33182-2238
US

V. Phone/Fax

Practice location:
  • Phone: 404-996-0120
  • Fax:
Mailing address:
  • Phone: 786-285-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9331226
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAANP000019
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: