Provider Demographics
NPI:1205826500
Name:SALANDY, SHELLY-ANN MICHELA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY-ANN
Middle Name:MICHELA
Last Name:SALANDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1680 MULKEY RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1118
Mailing Address - Country:US
Mailing Address - Phone:770-941-5107
Mailing Address - Fax:770-944-1013
Practice Address - Street 1:1680 MULKEY RD
Practice Address - Street 2:SUITE E
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1118
Practice Address - Country:US
Practice Address - Phone:770-941-5107
Practice Address - Fax:770-944-1013
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA057184208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA440133094DMedicaid