Provider Demographics
NPI:1649306937
Name:SHAH, LEENA (PA)
Entity type:Individual
Prefix:MS
First Name:LEENA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-422-1372
Mailing Address - Fax:770-423-9651
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 420
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-422-1372
Practice Address - Fax:770-423-9651
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2019-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA004360363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ45525Medicare UPIN