Healthcare Provider Details

I. General information

NPI: 1285019885
Provider Name (Legal Business Name): TAIWO SHEYIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 HIGHWAY 54 W
FAYETTEVILLE GA
30214-4526
US

IV. Provider business mailing address

352 BLOOMBRIDGE WAY NW
MARIETTA GA
30066-3488
US

V. Phone/Fax

Practice location:
  • Phone: 770-719-5630
  • Fax:
Mailing address:
  • Phone: 347-313-5361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number80577
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number80577
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: