Healthcare Provider Details

I. General information

NPI: 1013872019
Provider Name (Legal Business Name): SHAILA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT ST STE 501
BERKELEY CA
94705-2190
US

IV. Provider business mailing address

13541 MEGANWOOD PL
LA MIRADA CA
90638-6525
US

V. Phone/Fax

Practice location:
  • Phone: 510-845-2240
  • Fax: 510-845-2240
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: