MEDICARE: MA SHAIRA LOLARGA BAYSA

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	363LF0000X	Family Nurse Practitioner	APRN-NP714082	GA

General Provider Information

NPI Number	:	1508709593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MA SHAIRA LOLARGA BAYSA

Provider Business Mailing Address
First Line	:	3400 STRATFORD RD NE APT 5410
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1712
Country	:	US
Telephone Number	:	813-405-7280
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 STRATFORD RD NE APT 5410
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-1712
Country	:	US
Telephone Number	:	813-405-7280
Fax Number	:

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

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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