Healthcare Provider Details

I. General information

NPI: 1992538565
Provider Name (Legal Business Name): SHAMA V PATEL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5395 RUFFIN RD STE 204
SAN DIEGO CA
92123-1338
US

IV. Provider business mailing address

5395 RUFFIN RD STE 204
SAN DIEGO CA
92123-1338
US

V. Phone/Fax

Practice location:
  • Phone: 858-571-3630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95031788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: