Provider Demographics
NPI:1972598852
Name:SHENOY, NALAND P (MD)
Entity Type:Individual
Prefix:DR
First Name:NALAND
Middle Name:P
Last Name:SHENOY
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 1:2121 FOUNTAIN DR STE J
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2900
Mailing Address - Country:US
Mailing Address - Phone:770-979-7466
Mailing Address - Fax:770-979-7455
Practice Address - Street 1:2121 FOUNTAIN DR STE J
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2900
Practice Address - Country:US
Practice Address - Phone:770-979-7466
Practice Address - Fax:770-979-7455
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053165207RE0101X
SC22558207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADH0728OtherRR MEDICARE GROUP NUMBER
GA52057418002OtherBCBS PROVIDER
GA7677440OtherAETNA PROVIDER #
GAP00037925OtherRAILROAD MEDICARE
GA7677440OtherAETNA PROVIDER #
GAP00037925OtherRAILROAD MEDICARE
H86958Medicare UPIN
GA020640705Medicaid
GA992398512AMedicaid
P00037925Medicare ID - Type UnspecifiedRR MEDICARE #