Healthcare Provider Details

I. General information

NPI: 1932454709
Provider Name (Legal Business Name): SHEENA PRAVIN PATEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 04/30/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 AIRWAY AVE STE G1
COSTA MESA CA
92626-4624
US

IV. Provider business mailing address

19782 MACARTHUR BLVD STE 300
IRVINE CA
92612-2417
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-5550
  • Fax: 714-708-2588
Mailing address:
  • Phone: 714-545-5550
  • Fax: 714-708-2588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA21163
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberPA21163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: