Individual
SHANNON NISHA DELLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-3672
Mailing address
1447 HARPER ST STE 4G, AUGUSTA, GA 30912-0020
(706) 721-3672
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01089536A
IN
208600000X
Surgery Physician
Primary
103463
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2018
Last updated
07/22/2026
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