MEDICARE: SHREYA PRASHANT PATEL

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1649031543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHREYA PRASHANT PATEL

Provider Business Mailing Address
First Line	:	19224 BRIARBROOK DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3757
Country	:	US
Telephone Number	:	516-996-8060
Fax Number	:

Provider Business Practice Location Address
First Line	:	19224 BRIARBROOK DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3757
Country	:	US
Telephone Number	:	516-996-8060
Fax Number	:

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

Provider Enumeration Date	:	01/17/2024
Last Update Date	:	01/17/2024

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