Healthcare Provider Details

I. General information

NPI: 1659876563
Provider Name (Legal Business Name): SHREYA PATEL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2018
Last Update Date: 12/05/2021
Certification Date: 12/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 N 4TH AVE
ADDISON IL
60101-2273
US

IV. Provider business mailing address

561 N 4TH AVE
ADDISON IL
60101-2273
US

V. Phone/Fax

Practice location:
  • Phone: 224-425-9456
  • Fax:
Mailing address:
  • Phone: 224-425-9456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.155151
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: