Provider Demographics
NPI:1790969111
Name:ELDAIF, SHADY MOUNIR (MD)
Entity Type:Individual
Prefix:DR
First Name:SHADY
Middle Name:MOUNIR
Last Name:ELDAIF
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 1:960 JOHNSON FY RD NE
Mailing Address - Street 2:STE. 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1631
Mailing Address - Country:US
Mailing Address - Phone:404-252-9063
Mailing Address - Fax:404-252-0873
Practice Address - Street 1:960 JOHNSON FY RD NE
Practice Address - Street 2:STE. 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1631
Practice Address - Country:US
Practice Address - Phone:404-252-9063
Practice Address - Fax:404-252-0873
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066029208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)