MEDICARE: MRS. SHILPA K PATEL MS, CNS

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	133NN1002X	Nutrition Education Nutritionist	CNS18322	IL

General Provider Information

NPI Number	:	1972262079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHILPA K PATEL MS, CNS

Provider Business Mailing Address
First Line	:	1896 W GREENLEAF DR
Second Line	:
City	:	ROUND LAKE
State	:	IL
Zip	:	60073-9772
Country	:	US
Telephone Number	:	847-863-4570
Fax Number	:

Provider Business Practice Location Address
First Line	:	1896 W GREENLEAF DR
Second Line	:
City	:	ROUND LAKE
State	:	IL
Zip	:	60073-9772
Country	:	US
Telephone Number	:	847-863-4570
Fax Number	:

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

Provider Enumeration Date	:	12/16/2021
Last Update Date	:	12/16/2021

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