Healthcare Provider Details

I. General information

NPI: 1336391481
Provider Name (Legal Business Name): SHIFA PATEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OGDEN AVE
AURORA IL
60504-7222
US

IV. Provider business mailing address

2000 OGDEN AVE
AURORA IL
60504-5893
US

V. Phone/Fax

Practice location:
  • Phone: 866-565-8607
  • Fax: 312-563-8661
Mailing address:
  • Phone: 866-565-8607
  • Fax: 312-563-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.003349
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: