Healthcare Provider Details

I. General information

NPI: 1124705785
Provider Name (Legal Business Name): SHAILEE PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 RIVERDALE ST
WEST SPRINGFIELD MA
01089-4656
US

IV. Provider business mailing address

935 RIVERDALE ST
WEST SPRINGFIELD MA
01089-4656
US

V. Phone/Fax

Practice location:
  • Phone: 413-737-1800
  • Fax:
Mailing address:
  • Phone: 631-796-2215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number14925
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10001631
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: