Healthcare Provider Details

I. General information

NPI: 1962997791
Provider Name (Legal Business Name): PRIYADARSHEE YOGESH PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 HEARNE AVE STE 320
SHREVEPORT LA
71103-3917
US

IV. Provider business mailing address

2727 HEARNE AVE STE 320
SHREVEPORT LA
71103-3917
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-6797
  • Fax: 318-212-6822
Mailing address:
  • Phone: 318-212-6797
  • Fax: 318-212-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT215740
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberMD478326
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number346365
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: