MEDICARE: SHALYN B AHMADI P.A.

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	363A00000X	Physician Assistant	003389	GA

General Provider Information

NPI Number	:	1629051263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHALYN B AHMADI P.A.

Provider Business Mailing Address
First Line	:	3400 OLD MILTON PKWY
Second Line	:	SUITE 270
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-3707
Country	:	US
Telephone Number	:	770-442-1911
Fax Number	:	770-663-8905

Provider Business Practice Location Address
First Line	:	4235 JOHNS CREEK PKWY STE A
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-6038
Country	:	US
Telephone Number	:	678-402-9550
Fax Number	:	678-802-5765

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	05/09/2024

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