Provider Demographics
NPI:1760512016
Name:DAYA, SHASHIKANT A (MD)
Entity Type:Individual
Prefix:
First Name:SHASHIKANT
Middle Name:A
Last Name:DAYA
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 1:3305 BOBBY BROWN PKWY
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5012
Mailing Address - Country:US
Mailing Address - Phone:404-806-8181
Mailing Address - Fax:770-456-5469
Practice Address - Street 1:3305 BOBBY BROWN PKWY
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-5012
Practice Address - Country:US
Practice Address - Phone:404-806-8181
Practice Address - Fax:770-456-5469
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2014-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA037520207Q00000X, 207U00000X, 207UN0901X, 207UN0902X, 207UN0903X
GA037520261QR0200X, 261QM1300X, 2085N0904X, 207QA0505X, 207QG0300X, 2083X0100X, 207Q00000X, 207UN0901X, 207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
No207UN0903XAllopathic & Osteopathic PhysiciansNuclear MedicineIn Vivo & In Vitro Nuclear Medicine
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7052OtherMEDICARE GROUP PIN
GA360335904BMedicaid
GA360335904BMedicaid
GAG84829Medicare UPIN