Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 83690 | GA |
N | 207RS0012X | Sleep Medicine | 46703 | AZ |
N | 207RS0012X | Sleep Medicine | 57280 | CT |
N | 207RS0012X | Sleep Medicine | 83690 | GA |
NPI | 1013192384 |
---|---|
Provider Name | Safal Shetty |
First Address | Douglasville, GA 30134-5632 |
Second Address | Douglasville, GA 30134-5632 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2008 |
Last Update Date | 02/10/2019 |