Shayan Bagheri, PA-C
Physician Assistant in Cumming, GA. Individual provider (NPI-1).
NPI number1205678554
StatusActive
Last updated in NPPESJun 18, 2024
Details
- NPI
- 1205678554
- Entity type
- Individual (NPI-1)
- Name
- Mr. Shayan Bagheri
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 8, 2024
- Certification date
- Jun 18, 2024
- Last updated
- Jun 18, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | – | – | Yes |
| 363AM0700X | Physician Assistant, Medical | – | GA |
Practice location
204 Canton RdCumming, GA 30040-2304
Phone 770-886-5437
Mailing address
204 Canton RdCumming, GA 30040-2304
Phone 770-886-5437
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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