Provider Demographics
NPI:1629051263
Name:AHMADI, SHALYN B (PA)
Entity Type:Individual
Prefix:
First Name:SHALYN
Middle Name:B
Last Name:AHMADI
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3400 OLD MILTON PKWY
Mailing Address - Street 2:SUITE 270
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3707
Mailing Address - Country:US
Mailing Address - Phone:770-442-1911
Mailing Address - Fax:770-663-8905
Practice Address - Street 1:3400 OLD MILTON PKWY
Practice Address - Street 2:SUITE 270
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-442-1911
Practice Address - Fax:770-663-8905
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA003389363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant