Provider Demographics
NPI: | 1942355458 |
---|---|
Name: | GHAIY, SHIVANI RAJAT (CRNA) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | SHIVANI |
Middle Name: | RAJAT |
Last Name: | GHAIY |
Suffix: | |
Gender: | F |
Credentials: | CRNA |
Other - Prefix: | |
Other - First Name: | SHIVANI |
Other - Middle Name: | J |
Other - Last Name: | PATEL |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | CRNA |
Mailing Address - Street 1: | PO BOX 551420 |
Mailing Address - Street 2: | |
Mailing Address - City: | FORT LAUDERDALE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33355-1420 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 800-243-3839 |
Mailing Address - Fax: | 855-851-4405 |
Practice Address - Street 1: | 1000 MEDICAL CENTER BLVD |
Practice Address - Street 2: | |
Practice Address - City: | LAWRENCEVILLE |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30046-7694 |
Practice Address - Country: | US |
Practice Address - Phone: | 770-277-3056 |
Practice Address - Fax: | 855-204-5244 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-01-24 |
Last Update Date: | 2023-01-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | RN167419 | 367500000X, 367500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
GA | 690286696A | Medicaid | |
GA | 690286696A | Medicaid | |
GA | 202I436897 | Medicare PIN |