Healthcare Provider Details

I. General information

NPI: 1669848289
Provider Name (Legal Business Name): VASEEM SHAIKH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2346 WISTERIA DR STE 110
SNELLVILLE GA
30078-6174
US

IV. Provider business mailing address

1778 PHILADELPHIA CT
LAWRENCEVILLE GA
30043-4912
US

V. Phone/Fax

Practice location:
  • Phone: 305-878-8889
  • Fax:
Mailing address:
  • Phone: 305-878-8889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7769
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68499
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number029282-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: