Provider Demographics
NPI:1699267351
Name:SHAHEED, SONYA DUBOSE (FNP-C)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:DUBOSE
Last Name:SHAHEED
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 1:2121 FOUNTAIN DR STE A
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2900
Mailing Address - Country:US
Mailing Address - Phone:770-736-3008
Mailing Address - Fax:770-687-2296
Practice Address - Street 1:2121 FOUNTAIN DR STE A
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2900
Practice Address - Country:US
Practice Address - Phone:770-736-3008
Practice Address - Fax:770-687-2296
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN215968174400000X, 363LF0000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily