Shaveanda L. Queen, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

040764 Issued in GA

Practice address

5582 Memorial Dr
Stone Mountain, GA 30083-3215

Phone

(404) 298-8998

Fax

(404) 298-7658

NPI assigned

Sep 20, 2006

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

Other identifiers 1

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: shaveanda.queen@oakhurst.gadirect.net
• Direct secure messaging: shaveanda.queen.1@9679.direct.athenahealth.com

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.

• Medcura Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Stone Mountain, GA
  • NPI 1417011487
  Medicare reassignment NPD
• Medcura Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Decatur, GA
  • NPI 1144515354
  NPD
• Medcura Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Atlanta, GA
  • NPI 1811761448
  NPD
• Medcura Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Stone Mountain, GA
  • NPI 1255779468
  NPD (past)
• Medcura Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Conyers, GA
  • NPI 1811333859
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418601600000",
    "number": "1972600922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5582 MEMORIAL DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833215",
            "telephone_number": "404-298-8998",
            "fax_number": "404-298-7658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5582 MEMORIAL DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833215",
            "telephone_number": "404-298-8998",
            "fax_number": "404-298-7658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUEEN",
        "first_name": "SHAVEANDA",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2014-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "040764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000717043D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Publix Super Markets Inc
• Publix Super Markets Inc
• Flortasha Laray Pullom, FNP-BC
• Pure Angels Home Care Services
• Qosc Home Care
• Quick Care EMS LLC
• Ambar Quinones Rodriguez
• Maria J Quinones, LVN/LPN
• Rachels' Personal Care Home Inc
• Takatha Rahman

• Pediatrics Physician in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2014; 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.