Provider Demographics
NPI:1790408185
Name:SHETTY, ARIELLE JESSICA (AG-ACNP)
Entity type:Individual
Prefix:
First Name:ARIELLE
Middle Name:JESSICA
Last Name:SHETTY
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 KILMINGTON SQ
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-8635
Mailing Address - Country:US
Mailing Address - Phone:412-360-9569
Mailing Address - Fax:
Practice Address - Street 1:1400 NORTHSIDE FORSYTH DR STE 250
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7701
Practice Address - Country:US
Practice Address - Phone:770-889-7118
Practice Address - Fax:770-844-7835
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA285862363LA2100X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology