Healthcare Provider Details

I. General information

NPI: 1649763848
Provider Name (Legal Business Name): SHIV PATEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10238 E HAMPTON AVE STE 501
MESA AZ
85209-3321
US

IV. Provider business mailing address

1902 S LOS ALTOS DR
CHANDLER AZ
85286-6706
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-7460
  • Fax:
Mailing address:
  • Phone: 856-340-1473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number012476
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number012476
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: