Provider Demographics
NPI:1326218686
Name:GANDHI, SHAILESH (MD)
Entity Type:Individual
Prefix:
First Name:SHAILESH
Middle Name:
Last Name:GANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 NAPA VALLEJO HWY.
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6293
Mailing Address - Country:US
Mailing Address - Phone:707-253-5000
Mailing Address - Fax:888-747-9242
Practice Address - Street 1:6555 SUGARLOAF PKWY
Practice Address - Street 2:SUITE 307-258
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4930
Practice Address - Country:US
Practice Address - Phone:770-277-7195
Practice Address - Fax:888-747-9242
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0341392084P0804X
CAC532842084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000494711BMedicaid
GA000494711BMedicaid