Healthcare Provider Details

I. General information

NPI: 1588380760
Provider Name (Legal Business Name): SHREENA PATEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL BLVD STE 480
ROSWELL GA
30076-4975
US

IV. Provider business mailing address

2500 HOSPITAL BLVD STE 130
ROSWELL GA
30076-4946
US

V. Phone/Fax

Practice location:
  • Phone: 770-475-3085
  • Fax:
Mailing address:
  • Phone: 470-267-1520
  • Fax: 770-999-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11259
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: