Healthcare Provider Details

I. General information

NPI: 1790488229
Provider Name (Legal Business Name): SHREYA PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 06/19/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W MICHIGAN ST
INDIANAPOLIS IN
46202-5209
US

IV. Provider business mailing address

340 W 10TH ST
INDIANAPOLIS IN
46202-3082
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-0275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: