Healthcare Provider Details

I. General information

NPI: 1366858656
Provider Name (Legal Business Name): SHALIN PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 UNIVERSITY AVE
RIVERSIDE CA
92521-0001
US

IV. Provider business mailing address

900 UNIVERSITY AVE
RIVERSIDE CA
92521-0001
US

V. Phone/Fax

Practice location:
  • Phone: 951-468-8011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA144153
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA144153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: