Healthcare Provider Details

I. General information

NPI: 1558616755
Provider Name (Legal Business Name): SHRUTI BHUPENDRA PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WELLNESS WAY
MILFORD DE
19963-4364
US

IV. Provider business mailing address

640 S. STATE STREET MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 516-554-3023
  • Fax:
Mailing address:
  • Phone: 302-480-1688
  • Fax: 302-480-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC1-0013118
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: