Provider Demographics
NPI:1154641975
Name:AYENGAR, SHUBH (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHUBH
Middle Name:
Last Name:AYENGAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SHUBH
Other - Middle Name:
Other - Last Name:SHARMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4245 JOHNS CREEK PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-9122
Mailing Address - Country:US
Mailing Address - Phone:678-990-3962
Mailing Address - Fax:678-623-3862
Practice Address - Street 1:4245 JOHNS CREEK PKWY STE A
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-9122
Practice Address - Country:US
Practice Address - Phone:678-990-3962
Practice Address - Fax:678-623-3862
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA93204207QS1201X
WAMD60968644207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine