Provider Demographics
NPI:1184894859
Name:KAPOOR, SHAILENDRA (MD)
Entity type:Individual
Prefix:DR
First Name:SHAILENDRA
Middle Name:
Last Name:KAPOOR
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-504-5678
Mailing Address - Fax:804-741-6213
Practice Address - Street 1:1100 LAKE HEARN DR STE 250&500
Practice Address - Street 2:KAISER PERMANENTE SANDY SPRINGS MEDICAL CENTER
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342-1523
Practice Address - Country:US
Practice Address - Phone:404-845-4500
Practice Address - Fax:804-741-6213
Is Sole Proprietor?:No
Enumeration Date:2008-03-09
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101245670207Q00000X
IL036.119478207Q00000X
GA076590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09633OtherGROUP PTAN
VAC05698OtherGROUP PTAN
VAC06778OtherGROUP PTAN