MEDICARE: MS. MICHELLE BRENDALEE SHAND CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	APRN-NP179009	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	179009	OTHER	GA	GEOEGIA BOARD OF NURSING

General Provider Information

NPI Number	:	1366884470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE BRENDALEE SHAND CPNP

Provider Business Mailing Address
First Line	:	101 REGENCY PARK DR STE 140
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-7076
Country	:	US
Telephone Number	:	770-957-8626
Fax Number	:	770-957-7200

Provider Business Practice Location Address
First Line	:	101 REGENCY PARK DR STE 140
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-7076
Country	:	US
Telephone Number	:	770-957-8626
Fax Number	:	770-957-7200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2013
Last Update Date	:	01/06/2026

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