Healthcare Provider Details

I. General information

NPI: 1366884470
Provider Name (Legal Business Name): MICHELLE BRENDALEE SHAND CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 REGENCY PARK DR STE 140
MCDONOUGH GA
30253-7076
US

IV. Provider business mailing address

101 REGENCY PARK DR STE 140
MCDONOUGH GA
30253-7076
US

V. Phone/Fax

Practice location:
  • Phone: 770-957-8626
  • Fax: 770-957-7200
Mailing address:
  • Phone: 770-957-8626
  • Fax: 770-957-7200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN-NP179009
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: