Healthcare Provider Details

I. General information

NPI: 1477878767
Provider Name (Legal Business Name): SHYAMAL PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N 6TH ST
PHOENIX AZ
85004-2155
US

IV. Provider business mailing address

PO BOX 33269
PHOENIX AZ
85067-3269
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-8222
  • Fax: 602-406-4146
Mailing address:
  • Phone: 602-406-4786
  • Fax: 916-636-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number52188
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: