Provider Demographics
NPI:1255629234
Name:SHAH, VASUDHA RANI (DPM)
Entity type:Individual
Prefix:DR
First Name:VASUDHA
Middle Name:RANI
Last Name:SHAH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:VASUDHA
Other - Middle Name:RANI
Other - Last Name:KAUSHISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:3925 JOHNS CREEK CT
Mailing Address - Street 2:SUITE C2
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6618
Mailing Address - Country:US
Mailing Address - Phone:678-871-0876
Mailing Address - Fax:678-871-0836
Practice Address - Street 1:3925 JOHNS CREEK CT
Practice Address - Street 2:SUITE C2
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6618
Practice Address - Country:US
Practice Address - Phone:678-871-0876
Practice Address - Fax:678-871-0836
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001248213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery