Healthcare Provider Details

I. General information

NPI: 1861133118
Provider Name (Legal Business Name): SHREY NINAD PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 GUERNEVILLE RD STE 800
SANTA ROSA CA
95403-7228
US

IV. Provider business mailing address

2448 GUERNEVILLE RD STE 800
SANTA ROSA CA
95403-7228
US

V. Phone/Fax

Practice location:
  • Phone: 707-772-7522
  • Fax: 707-736-7254
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number197825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: