Provider Demographics
NPI:1265091896
Name:SHAH, NITI R (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:NITI
Middle Name:R
Last Name:SHAH
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 CUMBERLAND PKWY SE STE 104
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4523
Mailing Address - Country:US
Mailing Address - Phone:214-293-5943
Mailing Address - Fax:
Practice Address - Street 1:2323 CUMBERLAND PKWY SE STE 104
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4523
Practice Address - Country:US
Practice Address - Phone:770-927-7424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010630235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist