Individual
SHAUNTAYE M ELLIOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
21 ORTHO LN, ATLANTA, GA 30329-2315
(404) 778-5277
Mailing address
21 ORTHO LN, ATLANTA, GA 30329-2315
(917) 691-0504
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
008795
GA
363A00000X
Physician Assistant
017516
NY
Other
Enumeration date
04/23/2014
Last updated
02/23/2022
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