Healthcare Provider Details

I. General information

NPI: 1730979840
Provider Name (Legal Business Name): SHREYA PATEL AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 MONTREAL RD
TUCKER GA
30084-6901
US

IV. Provider business mailing address

440 SIMONTON CREST DR
LAWRENCEVILLE GA
30045-3510
US

V. Phone/Fax

Practice location:
  • Phone: 770-638-1400
  • Fax:
Mailing address:
  • Phone: 678-665-3583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN306905
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: