Provider Demographics
NPI:1053651455
Name:SHETTY, DANNA KATHRYN CONBOY (PA-C)
Entity Type:Individual
Prefix:
First Name:DANNA
Middle Name:KATHRYN CONBOY
Last Name:SHETTY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANNA
Other - Middle Name:KATHRYN
Other - Last Name:CONBOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:993 JOHNSON FERRY RD BUILDING F STE 210
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1620
Mailing Address - Country:US
Mailing Address - Phone:404-256-1727
Mailing Address - Fax:
Practice Address - Street 1:993 JOHNSON FERRY RD BUILDING F STE 210
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1620
Practice Address - Country:US
Practice Address - Phone:404-256-1727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-21
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant