| Sha Diabetes Center Llc | |
|
172 Luds Way Dothan AL 36304-8803 | |
| (334) 475-0646 | |
| (334) 888-8445 |
| Full Name | Sha Diabetes Center Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 172 Luds Way, Dothan, Alabama |
| Authorized Official Name and Position | Tai Bolaji (DR./CEO) |
| Authorized Official Contact | 3347787090 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sha Diabetes Center Llc 172 Luds Way, P. O. Box 8803 Dothan AL 36304-8803 Ph: (334) 778-7090 | Sha Diabetes Center Llc 172 Luds Way Dothan AL 36304-8803 Ph: (334) 475-0646 |
| NPI Number | 1063293603 |
|---|---|
| Provider Enumeration Date | 10/10/2023 |
| Last Update Date | 01/12/2024 |
| Medicare PECOS PAC ID | 0446697759 |
|---|---|
| Medicare Enrollment ID | O20240322000495 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063293603 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Toyin F Bolaji |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699752808 PECOS PAC ID: 7911273586 Enrollment ID: I20171026000442 |
| Provider Name | Brandy Michelle Long |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497255160 PECOS PAC ID: 8022368141 Enrollment ID: I20180911000271 |
| Provider Name | Shanda Leeann Crowe |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1558123950 PECOS PAC ID: 3678912722 Enrollment ID: I20240422003019 |
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