Healthcare Provider Details

I. General information

NPI: 1154825289
Provider Name (Legal Business Name): SHAMMI A PATEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N L ROGERS WELLS BLVD
GLASGOW KY
42141-1300
US

IV. Provider business mailing address

419 SW 15TH AVE STE 203
OCALA FL
32608
US

V. Phone/Fax

Practice location:
  • Phone: 270-659-5990
  • Fax: 270-659-5947
Mailing address:
  • Phone: 305-814-7246
  • Fax: 352-517-8952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number000000000
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOS21002
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberOS21002
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: