Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Shandareda Chantay Cavazos, PA-C, MMSC

Individual provider Physician Assistant · NPI 1538319249

Shandareda Chantay Cavazos, PA-C, MMSC is a Physician Assistant in Atlanta, Georgia. Qualified in 2005, 21 years ago. Practices with Northside Surgical Professional Services LLC, a 368-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
21
Licensed in
GA
In the registry since
2008
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1100 Johnson Ferry Rd Ste 410
Atlanta, GA 30342-1709
Phone: (404) 847-0664
Fax: (404) 250-1694
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 004742 (GA)

Record details

NPI number1538319249
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C , MMSC
Sole proprietorNo
NPI enumeratedSeptember 30, 2008
Last updated in NPPESAugust 26, 2024
Certification dateAugust 26, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2005 (21 years in practice)
Group practice Northside Surgical Professional Services Llc — 368 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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