Provider Demographics
NPI:1003187709
Name:DINI, SHEILA MAHSA (PA-C)
Entity type:Individual
Prefix:MISS
First Name:SHEILA
Middle Name:MAHSA
Last Name:DINI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1071
Mailing Address - Country:US
Mailing Address - Phone:404-223-0792
Mailing Address - Fax:404-223-5815
Practice Address - Street 1:550 PEACHTREE ST NE STE 1185
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2236
Practice Address - Country:US
Practice Address - Phone:404-223-0792
Practice Address - Fax:404-223-5815
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363AM0700X
GA006378363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003122889BMedicaid
GA003122889CMedicaid
GA202I972744OtherMEDICARE PTAN