Healthcare Provider Details

I. General information

NPI: 1477437424
Provider Name (Legal Business Name): SHIVANGI NAYAN PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E BAY DR STE 1
LARGO FL
33771-5616
US

IV. Provider business mailing address

602 BRIGADOON DR
CLEARWATER FL
33759-2949
US

V. Phone/Fax

Practice location:
  • Phone: 727-585-5675
  • Fax:
Mailing address:
  • Phone: 860-865-9602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code125J00000X
TaxonomyDental Therapist
License NumberDN30369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: