Healthcare Provider Details

I. General information

NPI: 1497315766
Provider Name (Legal Business Name): SHAIVI ASIT PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2023 PULASKI HWY
HAVRE DE GRACE MD
21078-2137
US

IV. Provider business mailing address

420 MOUNTAIN AVE FL 4
NEW PROVIDENCE NJ
07974-2736
US

V. Phone/Fax

Practice location:
  • Phone: 410-939-6477
  • Fax: 410-939-6555
Mailing address:
  • Phone: 908-458-8333
  • Fax: 908-530-6522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0096963
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: