MEDICARE: SHREYABEN T PATEL DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	063482	NY

General Provider Information

NPI Number	:	1316685860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHREYABEN T PATEL DMD

Provider Business Mailing Address
First Line	:	77 WREXHAM RD
Second Line	:
City	:	BRONXVILLE
State	:	NY
Zip	:	10708-5810
Country	:	US
Telephone Number	:	856-278-3986
Fax Number	:	212-410-4424

Provider Business Practice Location Address
First Line	:	563 W 169TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3912
Country	:	US
Telephone Number	:	212-923-3375
Fax Number	:	646-253-1270

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2022
Last Update Date	:	03/21/2025

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