Shivani Shivkumar Mallishery

Primary specialty

DentistTaxonomy code 122300000X

License

DN123318 Issued in GA

Practice address

3999 Austell Rd Ste 211
Austell, GA 30106-1144

Phone

(770) 732-3364

NPI assigned

Jan 18, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Austell Smiles Dentistry, PC

  • General Practice Dentistry
  • Austell, GA
  • NPI 1083011654
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1396506192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3999 AUSTELL RD",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061100",
            "telephone_number": "770-732-3364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3999 AUSTELL RD STE 211",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061144",
            "telephone_number": "770-732-3364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLISHERY",
        "first_name": "SHIVANI SHIVKUMAR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-18",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN123318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Alyce Makaroff, D.O.
• Benadette Kerubo Makori-Nelson, MD
• George E Malcom III, MD
• Manu Malepati, M.D.
• Saleem N Malik, MD
• Deborah Pauline Malone
• Ellis L Malone, MD
• Faye E. Spector Maloney, MD
• Kamal Kishore Mandalapu, M.D.
• Harvey A Mannes, M.D.

• Dentist in Austell, GA
• Providers in Austell, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.