MEDICARE: SHUVRO DE MD

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	2088P0231X	Pediatric Urology Physician	82744	GA

General Provider Information

NPI Number	:	1508125865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHUVRO DE MD

Provider Business Mailing Address
First Line	:	1930 BRANNAN RD
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-4310
Country	:	US
Telephone Number	:	678-284-4686
Fax Number	:

Provider Business Practice Location Address
First Line	:	5730 GLENRIDGE DR STE 200
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5579
Country	:	US
Telephone Number	:	404-252-5206
Fax Number	:

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

Provider Enumeration Date	:	05/08/2012
Last Update Date	:	05/16/2019

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