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NPI Code Detail

MEDICARE: SHAUNTAYE M ELLIOTT PA

MEDICARE: SHAUNTAYE M ELLIOTT PA
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
1363A00000XPhysician Assistant017516NY
2363A00000XPhysician Assistant008795GA

General Provider Information

NPI Number : 1922428465
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAUNTAYE M ELLIOTT PA
Provider Business Mailing Address
First Line : 21 ORTHO LN
Second Line :
City : ATLANTA
State : GA
Zip : 30329-2315
Country : US
Telephone Number : 917-691-0504
Fax Number :
Provider Business Practice Location Address
First Line : 21 ORTHO LN
Second Line :
City : ATLANTA
State : GA
Zip : 30329-2315
Country : US
Telephone Number : 404-778-5277
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2014
Last Update Date : 02/23/2022

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Directions to “ SHAUNTAYE M ELLIOTT PA” Practice Location

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