Healthcare Provider Details

I. General information

NPI: 1871457366
Provider Name (Legal Business Name): SHTARA REDDEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 BRADFORD CREEK TRL
DULUTH GA
30096-1402
US

IV. Provider business mailing address

11585 JONES BRIDGE RD STE 420
JOHNS CREEK GA
30022-7476
US

V. Phone/Fax

Practice location:
  • Phone: 716-374-1880
  • Fax:
Mailing address:
  • Phone: 716-374-1880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN308073
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: