Healthcare Provider Details

I. General information

NPI: 1366488793
Provider Name (Legal Business Name): SHILPA R SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 MONTREAL RD STE 180
TUCKER GA
30084-8187
US

IV. Provider business mailing address

1390 MONTREAL RD STE 180
TUCKER GA
30084-8187
US

V. Phone/Fax

Practice location:
  • Phone: 404-446-4600
  • Fax: 404-446-4601
Mailing address:
  • Phone: 919-923-2750
  • Fax: 404-446-4601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number043477
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200301286
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: