Provider Demographics
NPI:1326218686
Name:GANDHI, SHAILESH (MD)
Entity type:Individual
Prefix:
First Name:SHAILESH
Middle Name:
Last Name:GANDHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 SUGARLOAF PKWY # 258-307
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4930
Mailing Address - Country:US
Mailing Address - Phone:770-277-7195
Mailing Address - Fax:888-747-9242
Practice Address - Street 1:1814 LAKEFIELD CT SE STE A
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1776
Practice Address - Country:US
Practice Address - Phone:770-277-7195
Practice Address - Fax:888-747-9242
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC532842084P0804X, 2084P0800X
GA0341392084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000494711BMedicaid
GA000494711BMedicaid