Provider Demographics
NPI:1407077845
Name:NDONG, SHASHANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHASHANNA
Middle Name:
Last Name:NDONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHASHANNA
Other - Middle Name:
Other - Last Name:BUTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:710 W HOBBS ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-1508
Mailing Address - Country:US
Mailing Address - Phone:256-262-6380
Mailing Address - Fax:256-262-6384
Practice Address - Street 1:710 W HOBBS ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-1508
Practice Address - Country:US
Practice Address - Phone:256-262-6380
Practice Address - Fax:256-262-6384
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263257207R00000X, 208000000X
IL036133172207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)