Healthcare Provider Details

I. General information

NPI: 1366681751
Provider Name (Legal Business Name): SADEKA SHAHANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 CHURCH ST NE
MARIETTA GA
30060-1101
US

IV. Provider business mailing address

625 CHURCH ST NE
MARIETTA GA
30060-1101
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-2004
  • Fax: 770-422-8465
Mailing address:
  • Phone: 770-422-2004
  • Fax: 770-422-8465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberBP10032140
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: