Provider Demographics
NPI:1346503810
Name:SHETTY, SHAANAN SATISH (MD)
Entity Type:Individual
Prefix:
First Name:SHAANAN
Middle Name:SATISH
Last Name:SHETTY
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1265 UPPER HEMBREE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1258
Mailing Address - Country:US
Mailing Address - Phone:770-751-1433
Mailing Address - Fax:770-751-7410
Practice Address - Street 1:1265 UPPER HEMBREE RD STE 100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1258
Practice Address - Country:US
Practice Address - Phone:770-751-1133
Practice Address - Fax:770-751-7410
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2020-11-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA075374207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology