Provider Demographics
NPI:1487417465
Name:EIDI, SHIVA (FNP-C)
Entity type:Individual
Prefix:
First Name:SHIVA
Middle Name:
Last Name:EIDI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 WINFORD PL
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8447
Mailing Address - Country:US
Mailing Address - Phone:678-430-2529
Mailing Address - Fax:
Practice Address - Street 1:5755 N POINT PKWY STE 34
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1144
Practice Address - Country:US
Practice Address - Phone:678-240-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN295702363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner